CABG associated with nearly three times the stroke risk of PCI

Coronary revascularization by coronary artery bypass graft (CABG) compared with percutaneous coronary intervention (PCI) is associated with an increased risk of stroke, a meta-analysis found.

Researchers performed a meta-analysis of 19 trials in which 10,944 patients were randomized to either procedure. The primary end point was the 30-day rate of stroke. They also determined the rate of stroke at the midterm follow-up and investigated whether there was an interaction between either procedure and the extent of coronary artery disease on the relative risk of stroke.

Results appeared in the Aug. 21 issue of the Journal of the American College of Cardiology.

The 30-day rate of stroke was 1.20% after CABG compared with 0.34% after PCI (odds ratio, 2.94; 95% CI, 1.69 to 5.09; P<0.0001). Similar results were observed after a median follow-up of 12.1 months (1.83% vs. 0.99%; odds ratio, 1.67; 95% CI, 1.09 to 2.56; P=0.02).

The extent of coronary artery disease (single vessel vs. multivessel vs. left main) did not affect the relative increase in the risk of stroke observed with CABG compared with PCI at either 30 days (P=0.57 for interaction) or midterm follow-up (P=0.08 for interaction), the authors noted.

Similar findings were observed when results from 27 studies, including 33,980 patients enrolled in observational studies, were analyzed. Patients treated with CABG had an increased risk of stroke compared with PCI both at 30 days and at a median follow-up of 14.2 months. Patients treated with CABG have an excess of seven strokes for every 1,000 patients treated, the authors concluded.