18. Benefit of CABG vs PTCA at 5 years

Hoffman et. al. J Am Coll Cardiol. 2003 Apr 16;41(8):1293-304

• Meta-analysis of randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous transluminal coronary angioplasty (PTCA)
• 13 randomized trials on 7,964 patients comparing PTCA with CABG.
  1.9% absolute survival advantage favoring CABG over PTCA for all trials at five years (p < 0.02)
• No significant advantage at one, three, or eight years.
• Patients randomized to PTCA had more repeat revascularizations at all time points (risk difference [RD] 24% to 38%, p < 0.001);
• With stents, this RD was reduced to 15% at one and three years.
• Stents also resulted in a significant decrease in nonfatal myocardial infarction at three years when compared with CABG.
• For diabetic patients, CABG provided a significant survival advantage over PTCA at 4 years but not at 6.5 years.
• CABG is associated with a lower five-year mortality, less angina, and fewer revascularization procedures compared to PTCA.
• Stents reduced the need for repeat revascularization by about half.

Benefit of CABG vs PTCA at 5 years

By the time you get out to eight years the survival advantage of CABG over PTCA is lost. So, if you plan to live exactly five years, choose CABG.