CABG better than PCI for smokers and those with diabetes, PAD, or heart failureBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2534 (Published 24 April 2013) Cite this as: BMJ 2013;346:f2534
Coronary artery bypass surgery (CABG) is currently nudging ahead of percutaneous coronary intervention (PCI) as the most effective procedure for adults with multivessel coronary heart disease. The latest study from the US confirms that surgery is associated with slightly better survival over five years (hazard ratio for all cause death 0.92, 95% CI 0.9 to 0.95). In a cohort of more than 100 000 older adults, those treated with CABG gained an extra 0.053 years of life over five years, but the gains weren’t evenly distributed. The survival advantage associated with CABG was concentrated among those with a history of diabetes, smoking, peripheral vascular disease (PAD), or heart failure⇑.
The authors analysed claims data from Medicare, federally funded healthcare for people aged 65 or over, to compare mortality after CABG and PCI. They used state of the art matching techniques (a propensity score) in an attempt to iron out the many baseline differences between patients choosing one or other treatment. The new study adds power and a more diverse patient mix to previous estimates comparing the two, they write. It also identifies some important clinical factors that should help inform patient choice.
Cite this as: BMJ 2013;346:f2534