According to a study, researchers estimate stroke rates are lower at 30 days and five years after percutaneous coronary intervention (PCI) than after coronary artery bypass grafting (CABG). The study was published in the Journal of the American College of Cardiology.

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI.

Researchers conducted a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents. The 30-day and five-year stroke rates were compared between CABG and PCI. A total of 11,518 patients randomized to PCI (5,753 patients) and CABG (5,765 patients) were included in the analysis.

Strokes

The researchers found that a total of 293 strokes occurred during a mean follow-up of 3.8 ± 1.4 years. The rate of stroke was 0.4 and 1.1% after PCI and CABG, respectively, at 30 days (hazard ratio, 0.33). Stroke remained significantly lower after PCI than after CABG at five-year follow-up (2.6 versus 3.2%; hazard ratio, 0.77). Between 31 days and five years, the rates of stroke did not differ significantly (2.2 and 2.1% after PCI and CABG, respectively).

This individual patient-data pooled analysis demonstrates that 5-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and 5 years.

The greater risk of stroke after CABG compared with PCI was confined to patients with multivessel disease and diabetes. Five-year mortality was markedly higher for patients experiencing a stroke within 30 days after revascularization.

Risk Of Stroke

This individual patient-data pooled analysis demonstrates that five-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and five years.