The following is a summary of the “Difference in spontaneous myocardial infarction and mortality in percutaneous versus surgical revascularization trials: A systematic review and meta-analysis,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Gaudino, et al.
It has been hypothesized that the lower rate of SMI after surgery may be responsible for the greater success rate of coronary artery bypass grafting (CABG) compared to percutaneous coronary intervention (PCI). The issue has yet to be studied formally, however. This meta-analysis assesses the relationship between SMI and survival in RCTs by comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG). The literature on randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of coronary artery disease was searched for studies that reported SMI outcomes.
Combining results from different studies as natural logarithms of incident rate ratios allowed us to use a generic inverse variance method. Trials that reported a significant decrease in SMI- in patients treated with CABG were compared with those that did not, using a subgroup analysis and interaction test to compare the difference in the primary outcome. All-cause mortality was the primary endpoint, with serious mental illness as a secondary endpoint. The meta-analysis included 20 randomized controlled trials. Seven included studies (35%) found a statistically significant improvement in SMI after CABG.
For mortality from any cause, PCI was associated with a higher risk (incidence rate ratio, 1.13; 95% CI, 1.01-1.28). Subgroup analysis revealed a favorable survival benefit for CABG only in trials with a significant reduction in SMI in the surgical arm (P for interaction 0.02). The protective effect of CABG against SMI is demonstrated in the published PCI versus CABG trials, where it is associated with the reduction in all-cause mortality in the surgical arm.
Source: sciencedirect.com/science/article/abs/pii/S0022522321007467