In an analysis of 11 randomized clinical trials, the rate of stroke at 5 years was significantly lower after PCI compared with CABG, and the reduction in stroke was primarily driven by fewer strokes in the 30 days after the procedure. However, risk for stroke was similar between 31 days and 5 years, researchers reported in the Journal of the American College of Cardiology.
The pooled analysis of trials comparing CABG vs. PCI with stents included the ARTS, BEST, ERACI II, EXCEL, FREEDOM, MASS II, NOBLE, PRE-COMBAT, SoS, SYNTAX and VA CARDS trials. Rates of stroke at 30 days and 5 years were compared between CABG and PCI by trial.
A total of 5,753 patients were randomly assigned to undergo PCI and 5,765 to undergo CABG. Mean follow-up across all trials was 3.8 years, during which 293 strokes were reported.
Rates of stroke were as follows:
- 0.4% after PCI vs. 1.1% after CABG at 30 days (HR = 0.33; 95% CI, 0.2-0.53);
- 2.2% after PCI vs. 2.1% after CABG from 31 days to 5 years (HR = 1.05; 95% CI, 0.8-1.38); and
- 2.6% after PCI and 3.2% after CABG at 5-year follow-up (HR = 0.77; 95% CI, 0.61-0.97).
Mortality at 5 years was higher among patients who experienced a stroke within 30 days of the procedure, compared with those without stroke: 45.7% vs. 11.1% after PCI (P < .001) and 41.5% vs. 8.9% after CABG (P < .001).
The researchers reported no significant associations between stroke at 5 years and treatment, baseline clinical characteristics or baseline angiographic variables, except patients with diabetes, in whom the rate of 5-year stroke was higher compared with patients without diabetes.
“The differential risks of stroke after PCI and CABG should be considered in the comprehensive assessment of the long-term risk-benefit ratio of these alternative revascularization options,” the researchers concluded.
Disclosures: Head reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.