Ischaemic heart disease: more patients are angina-free and have fewer revascularisations with CABG.

Clinical bottom line (level 1a)

  1. Patients with multivessel coronary artery disease who have CABG compared with PTCA have less angina (NNT = 13 at 3 years) , and fewer require further CABG (NNT = 5 at 3 years) or PTCA (NNT = 6 at 3 years) .
  2. The effect on mortality is unclear.
Sim et al: American Journal of Cardiology 1995; 76: 1025-1029
Expires June 2003

The study

Systematic review of randomised controlled trials of
  • Patients: multivessel coronary artery disease
  • Intervention: coronary artery bypass grafting (CABG) compared with percutaneous transluminal coronary angioplasty (PTCA)
  • Outcome: death or non-fatal MI, angina-free, CABG, PTCA
Articles found in English using MEDLINE and BIOSIS, 1985 to 1995 (search terms: using Cochrane Collaboration search strategy- not stated ) and bibliographies were searched, authors and experts contacted for unpublished studies or other relevant articles.

Selection criteria: as above
Appraisal criteria: two independent blinded reviewers using set criteria (not detailed in text)
Articles excluded if:

five studies involving 2943 patients (~80% male; mean age ~59 years); 1449 randomised to CABG and 1494 to PTCA
heterogeneity was not reported

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
death or non-fatal MI 1-3 years /
(9.8%)		 1.03
(0.81 to 1.32) 		-380
(NNT = 58 to infinity;
NNH = 36 to infinity)
angina-free 1-3 years /
(73.1%)		 1.57
(1.32 to 1.87) 		-13
(-20 to -10)
CABG 1-3 years /
(19.7%)		 0.04
(0.02 to 0.07) 		5
(5 to 6)
PTCA 1-3 years /
(22.9%)		 0.21
(0.16 to 0.27) 		6
(5 to 6)

Comments

  1. Other systematic reviews have shown that CABG can reduce mortality in patients with multivessel disease.

Citation

  1. Sim I, Gupta M, McDonald K, et al: A meta-analysis of randomized trials comparing coronary artery bypass grafting with percutaneous transluminal coronary angioplasty in multivessel coronary artery disease. American Journal of Cardiology 1995; 76: 1025-1029
Search Terms: angioplasty in Cochrane
Contributor: Chris Ball and Clare Wotton, June 2000
Reviewer:

Clinical Question.
Patient multivessel coronary artery disease
Intervention or Exposure CABG
Comparison PTCA
Outcome death, MI, angina