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Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are mechanical ways of unblocking diseased coronary arteries. Most people have the kind of disease best suited to one or the other. But a few people have intermediate coronary artery disease treatable by either procedure. How should they choose between the two?
In a meta-analysis of 23 randomised trials comparing the two, the key findings were that short term and long term survival are about the same for CABG and PCI (90.7% v 89.7% at five years), even for people with diabetes; CABG seems better at relieving angina, but it is associated with a higher risk of early stroke (1.2% v 0.6%, P=0.002). People who have PCI are more likely to need a repeat procedure within five years than people who have a CABG (40.1% after PCI with stent v 9.8%). Cardiologists should make sure their patients understand these differences when discussing treatment options, says a linked editorial.
They should also understand that these facts apply only to the relatively young fit people included in these trials. Most trials excluded anyone over 75, and those with heart failure, unstable symptoms, or a previous history of revascularisation. Only one trial used modern drug eluting stents. The rest used bare metal stents (13 trials) or balloon angioplasty.