• Mario Gaudino, Katia Audisio, Whady A Hueb, Gregg W Stone, Michael E Farkouh, Antonino Di Franco, Mohamed Rahouma, Patrick W Serruys, Deepak L Bhatt, Biondi ZoccaiGiuseppeGDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy., Salim Yusuf, Leonard N Girardi, Stephen E Fremes, Marc Ruel, and Bjorn Redfors.
• Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY. Electronic address: mfg9004@med.cornell.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Mar 1; 167 (3): 10221032.e141022-1032.e14.

ObjectivesIt is unclear whether coronary artery bypass grafting (CABG) improves survival compared with medical therapy (MT) in patients with stable coronary artery disease (CAD). The aim of this analysis was to perform an individual-patient data-pooled meta-analysis of contemporary randomized controlled trials that compared CABG and MT in patients with stable CAD.MethodsA systematic search was performed in January 2021 to identify randomized controlled trials enrolling adult patients with stable CAD, randomized to CABG or MT. Only trials using at least aspirin, beta-blockers, and statins in the MT arm were included. Individual patient data were obtained from all eligible studies and pooled. The primary outcome was all-cause mortality.ResultsFour trials involving 2523 patients (1261 CABG; 1262 MT) were included with a median follow-up of 5.6 (4.0-9.2) years. CABG was associated with increased risk of all-cause mortality within 30 days (hazard ratio [HR], 4.81; 95% confidence interval [CI], 1.95-11.83) but subsequent reduction in the long-term risk of death (HR, 0.79; 95% CI, 0.69-0.89). As such, the cumulative 10-year mortality rate was lower in patients treated with CABG compared with MT (45.1% vs 51.7%, respectively; odds ratio, 0.70; 95% CI, 0.58-0.85). Age and race were significant treatment effect modifier (interaction P = .003 for both).ConclusionsIn patients with stable CAD, initial allocation to CABG was associated with greater periprocedural risk of death but improved long-term survival compared with MT. The survival advantage for CABG became significant after the fourth postoperative year and was particularly pronounced in younger and non-White patients.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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