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CABG and PCI Each Have Strengths, Weaknesses

Coronary procedures have similar survival rates, but differ on angina relief, stroke and revascularizations

WEDNESDAY, Oct. 17 (HealthDay News) -- Survival rates for patients who have coronary artery bypass graft (CABG) surgery are about the same as they are for patients who have percutaneous coronary intervention (PCI), but beyond that, each procedure type has advantages and disadvantages, according to a systematic review of randomized trials published online Oct. 16 in the Annals of Internal Medicine.

Dena M. Bravata, M.D., of the Stanford University School of Medicine in Stanford, Calif., and colleagues reviewed 23 randomized, controlled trials in which a total of 5,019 patients had PCIs and 4,944 had CABG. The surveys covered the years 1966 through 2006, and included a variety of forms of both procedures. Patients were mostly of European ancestry, 27 percent were female and were an average 61 years old.

The survival difference between patients who had the two types of procedures over all measured time periods (including 30 days, one year and five years) was less than 1 percent. Patients undergoing CABG were more likely to experience angina relief than PCI patients. CABG patients were also less likely to undergo repeated revascularization procedures (a risk difference of 24 percent at one year and 33 percent at five years), but the rate of procedural stroke was higher after CABG (1.2 percent) than after PCI (0.6 percent).

"Our analysis has identified numerous gaps in evidence of comparative effectiveness of PCI and CABG that are opportunities for future research," the authors conclude.

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