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Comment & Response
June 2014

Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention in Multivessel Disease

Author Affiliations
  • 1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
JAMA Intern Med. 2014;174(6):1006-1007. doi:10.1001/jamainternmed.2014.773

To the Editor We read with great interest the meta-analysis by Sipahi et al1 in which 6 randomized clinical trials (RCTs) of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in multivessel disease (MVD) were included. There was a significant reduction in 1-year-or-greater all-cause mortality with CABG compared with PCI (risk ratio [RR], 0.73; 95% CI, 0.62-0.86; P < .001). The design of included RCTs, however, is heterogeneous: ie, using exclusively bare-metal stents (BMS) in 3 trials, drug-eluting stents (DES) in 2 trials (SYNTAX [Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery] multivessel and FREEDOM [Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease] [references 12 and 16, respectively, in the original article1]), and both BMS and DES in 1 trial (CARDia [Coronary Artery Revascularization in Diabetes] [reference 7 in the original article1]). The authors stated that their aim was to “overcome the power limitation” of the existing data sets.1(p224) Pooling heterogeneous-design RCTs just merely to overcome the power limitation (thereby, probably expecting statistically significant results), however, would be inappropriate.

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