Bypass Grafting Versus Percutaneous Intervention in Multivessel Coronary Disease: the Current State

Whether stenting or coronary artery bypass grafting (CABG) is the best revascularization strategy in patients with multivessel disease has been a heavily debated controversy. The trials comparing the two methods were unfortunately underpowered for mortality. Moreover, results of clinical trials appeared to contradict with each other. Because CABG is unequivocally a more cumbersome method, stenting became commonly preferred in the absence of evidence for mortality difference. Meta-analysis is a powerful tool, especially when several high-quality randomized trials are available on the same issue. In these instances, meta-analyses can overcome the power limitation of the individual trials. Our recent meta-analysis reveals that, as compared to stenting, CABG leads to unequivocal reductions in mortality and myocardial infarctions in patients with multivessel disease. These benefits are seen regardless of whether patients are diabetic or not and also do not depend on whether bare-metal or drug-eluting stents are used.