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October 13, 2020

Higher Rates of Cardiac, Noncardiac, and All-Cause Mortality Shown for PCI Versus CABG

October 13, 2020—A meta-analysis published in JAMA Internal Medicine found percutaneous coronary intervention (PCI) was associated with a significantly higher rate of cardiac, noncardiac, and all-cause mortality compared with coronary artery bypass grafting (CABG). The study was published online ahead of print by Mario Gaudino, MD, et al.

Researchers evaluated 23 randomized controlled trials comparing PCI using drug-eluting or bare-metal stents and CABG for the treatment of coronary artery disease. All studies reported mortality and/or cause-specific mortality. Trials of PCI involving angioplasty without stenting were excluded. For each trial included, the longest follow-up duration outcomes were used.

A total of 13,620 unique patients were included in the analysis (6,829 patients with PCI and 6,791 patients with CABG). The mean age was 60 to 71 years. The weighted mean follow-up was 5.3 (SD, 3.6) years.

Compared with CABG, PCI was associated with a higher rate of all-cause (incident rate ratio [IRR], 1.17; 95% CI, 1.05-1.29), cardiac (IRR, 1.24; 95% CI, 1.05-1.45), and noncardiac mortality (IRR, 1.19; 95% CI, 1.00-1.41).

The study authors concluded these data suggest the use of all-cause mortality as an endpoint for myocardial revascularization trials is appropriate because the significantly higher noncardiac mortality associated with PCI suggests that even noncardiac deaths after PCI may be procedure-related.

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