Long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting in women, a meta-analysis

Background Despite the advances in the last decades for treatment of ischemic heart disease, women continue to experience poorer prognosis than men and currently, there is a gap in knowledge regarding the optimal revascularization strategy in women. Objective Compare the long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of stable ischemic heart disease in women. Methods A systematic search was conducted including randomized clinical trials (RCTs) comparing PCI with drug-eluting stents with CABG. The primary outcome were the composite outcomes of death, stroke or myocardial infarction (MI) and death, stroke, MI or repeat revascularization. Secondary outcomes included the individual components of the primary outcomes. Pooled hazard ratios with 95% confidence intervals were calculated in a fixed- effects meta-analysis using the inverse of variance method. Risk of bias and sensitivity analyses were also conducted. Results Six multicenter, RCTs were included after eligibility assessment. Median follow-up was 6.25 years (IQR: 5- 2.5). A significant benefit for CABG over PCI was observed for the primary composite outcomes of death, stroke, MI (HR = 1.24; 95% CI 1.01-1.52; p = 0.037) and death, stroke, MI or repeat revascularization (HR = 1.60; 95% CI 1.25-2.03; p < 0.000). Conclusion In the present study-level metanalysis, CABG is associated with a lower risk of major adverse cardiovascular events than PCI at long term follow-up in women.