Angina: CABG leads to less revascularisation and angina than PTCA

Clinical bottom line (level 1b)

  1. Patients with coronary heart disease requiring revascularisation who had CABG compared with PTCA using stents were less likely to have a cardiac event (death, stroke, myocardial infarction or repeat revascularisation) (NNT = 7 at 12 months) .
  2. Patients who underwent CABG were less likely to require a CABG (NNT = 24 at 12 months) or PTCA (NNT = 11 at 12 months) .
  3. Patients who had CABG were less likely to have angina (NNT = 5 at 12 months) or require antianginal medication (NNT = 5 at 12 months) .
Serruys et al: New England Journal of Medicine 2001; 344 : 1117-1124
Expires October 2001

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 67 acute hospitals, Europe, South America, New Zealand, Israel

1205 patients (aged 30 to 83; mean 61, 76% male) with stable or unstable angina, or silent ischaemia and at least 2 new lesions located in different vessels and territories and that were potentially amenable to stent implantation.

Excluded if
  • intolerance or contraindication to aspirin or ticlopidine
  • needed concomitant major surgery (e.g. valve replacement, resection of aortic aneurysm)
  • transmural myocardial infarction in previous week
  • severe hepatic or renal disease
  • diseased saphenous veins
  • neutropenia or thrombocytopenia
  • previously undergone bypass surgery or angioplasty
  • overt heart failure or ejection fraction < 30%
  • history of a stroke

Control Group: (n = 600, 600 analysed): angioplasty using stents
Experimental Group: (n = 605, 605 analysed): coronary artery bypass grafting

100% followed for 12 months
Outcome notes:
  • cardiac event : death, stroke, tranisent ischaemic attack, nonfatal myocardial infarction, or repeat revascularization

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
cardiac event 12 months 157
(26.2%)		 74
(12.2%)		 53%
(40% to 64%)		 13.9%
(9.56% to 18.3%)		 7
(5 to 10)
CABG required 12 months 28
(4.67%)		 3
(0.50%)		 89%
(65% to 97%)		 4.17%
(2.39% to 5.95%)		 24
(17 to 42)
PTCA required 12 months 73
(12.2%)		 18
(2.98%)		 76%
(60% to 85%)		 9.19%
(6.25% to 12.1%)		 11
(8 to 16)
free from angina 12 months 474
(79.0%)		 542
(89.6%)		 13%
(8% to 19%)		 10.6%
(6.52% to 14.7%)		 9
(7 to 15)
off anti-anginal medication 12 months 127
(21.2%)		 251
(41.5%)		 96%
(64% to 135%)		 20.3%
(15.2% to 25.4%)		 5
(4 to 7)

Comments

  1. 67% of patients had 2 diseased vessels. 31% had 3 diseased vessels.
  2. 40% of complications that occured the stented group in the first 30 days were due to stent thrombosis - involving 2.8% of patients.
  3. The study is too small to show any difference in mortality, stroke or myocardial infarction between the 2 groups.

Citation

  1. Serruys PW, Unger F, Sousa JE, et al: comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. New England Journal of Medicine 2001; 344 : 1117-1124
Search Terms: handsearch
Contributor: Chris Ball, October 2001
Reviewer:

Clinical Question.
Patient coronary heart disease
Intervention or Exposure
Outcome