Table 3.
Revascularization
| Reference | Inclusion/Exclusion | Intervention/Subgroup | n | Mean age | Gender (% male) | Time point | PL | AS | AF | TS | DP | EQ-5D |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zhang et al48 | (I) Multivessel IHD, revascularization was clinically indicated and appropriate. (E) Previous revascularization, thoracotomy, intervention for pathology of the valves, great vessels, or aorta. |
1. PCI | 488 | 61.0 | 80.0 | Baseline | 56.6 (1.02) | 47.4 (1.45) | 55.8 (1.26) | 86.7 (0.65) | 39.5 (0.90) | 0.720 (0.71–0.73) |
| 2. CABG | 500 | 62.0 | 78.0 | Baseline | 54.3 (0.98) | 45.0 (1.41) | 53.8 (1.25) | 86.2 (0.67) | 37.0 (0.91) | 0.708 (0.70–0.72) | ||
| Andréll et al18 | (I) Refractory and severe stable angina (CCS class III–IV) despite optimal conventional pharmacological therapy. | 1. Refractory angina | 139 | 70.0 | 73.0 | Baseline | 51.9 (2.16) | 50.3 (2.83) | 48.4 (3.09) | 66.9 (2.65) | 46 (2.63) | 0.710 (0.69–0.73) |
| 1 year | 55.8 (2.39) | 59.4 (3.77) | 60.7 (4.45) | 72.7 (2.76) | 53.4 (3.09) | 0.747 (0.73–0.77) | ||||||
| 2. Stable angina and revascularization | 139 | 72.0 | 73.0 | 1 year | 66 (3.43) | 71.7 (4.60) | 80.9 (4.11) | 78.5 (3.51) | 64.4 (4.21) | 0.813 (0.79–0.84) | ||
| Kim et al49 | (I) Chest pain at rest, documented electrocardiographic or arteriographic evidence of IHD. | 1. Early interventional strategy – maximal medical therapy and early coronary arteriography with possible myocardial revascularization. | 895 | 63.0 | 61.0 | 4 months | 75.4 (0.90) | 70.3 (1.00) | 80.2 (0.90) | 90.1 (0.50) | 72.1 (0.90) | 0.853 (0.84–0.86) |
| 1 year | 76.9 (1.00) | 67.7 (1.00) | 82.4 (0.90) | 91.2 (0.50) | 75.9 (0.90) | 0.868 (0.86–0.88) | ||||||
| 2. Conservative strategy – maximal medical therapy and ischemia – or symptom-provoked angiography and revascularization. | 915 | 62.0 | 64.0 | 4 months | 69.8 (0.90) | 63.9 (1.00) | 72.6 (0.90) | 86.3 (0.50) | 64.4 (0.80) | 0.816 (0.81–0.82) | ||
| 1 year | 73.3 (1.00) | 63.7 (1.00) | 78.0 (0.90) | 88.6 (0.50) | 71.2 (0.90) | 0.845 (0.84–0.85) | ||||||
| Hofer et al50 | (I) Patients with angina symptoms referred for angiographic screening of IHD. Following angiogram treatment decision (CABG, PCI, or medical management) was made as per clinical indication. | 1. All patients | 158 | 64.5 | 67.7 | Baseline | 61.6 (2.99) | 53.9 (2.68) | 45.0 (1.92) | 84.7 (1.35) | 48.9 (2.08) | 0.738 (0.72–0.76) |
| 1 year | 63.7 (2.13) | 68.4 (2.44) | 72.7 (2.18) | 82.5 (0.46) | 64.7 (2.16) | 0.803 (0.79–0.82) | ||||||
| 2. CCS class I | 22 | NA | NA | Baseline | 64.9 (9.45) | 57.1 (11.19) | 40.0 (10.41) | 89.6 (3.85) | 51.9 (9.86) | 0.747 (0.68–0.81) | ||
| 3. CCS class II | 20 | NA | NA | Baseline | 67.9 (6.48) | 46.4 (10.15) | 54.2 (8.51) | 89.5 (3.48) | 53.2 (7.44) | 0.774 (0.73–0.82) | ||
| 4. CCS class III | 62 | NA | NA | Baseline | 61.5 (3.90) | 61.1 (4.71) | 44.9 (4.27) | 85.0 (2.34) | 55.3 (3.77) | 0.751 (0.72–0.78) | ||
| 5. CCS class IV | 54 | NA | NA | Baseline | 60.5 (4.47) | 54.7 (4.66) | 45.1 (3.72) | 84.8 (2.52) | 41.7 (3.61) | 0.719 (0.69–0.75) | ||
| Graham et al26 | (I) IHD. (E) Undergoing investigation for valvular heart disease, without IHD on angiography, no consent for follow-up. |
1. Age <70 years: | ||||||||||
| A. Medical therapy | 3,488 | 59.2 (median) | 68.9 | 1 year | 72.8 (0.18) | 75.3 (0.07) | 84.1 (0.10) | 84.4 (0.05) | 71.1 (0.07) | 0.846 (0.84–0.85) | ||
| 3 years | 73.5 (0.18) | 74.9 (0.07) | 84.6 (0.07) | 84.8 (0.05) | 71.6 (0.07) | 0.849 (0.84–0.86) | ||||||
| B. CABG | 1,697 | 61.6 (median) | 83.9 | 1 year | 74.2 (0.26) | 78.6 (0.10) | 86.2 (0.13) | 86.9 (0.05) | 73.3 (0.10) | 0.856 (0.85–0.86) | ||
| 3 years | 74.7 (0.28) | 78.1 (0.10) | 86.6 (0.13) | 87.1 (0.07) | 74.0 (0.10) | 0.859 (0.85–0.87) | ||||||
| C. PCI | 2,698 | 59.1 (median) | 78.4 | 1 year | 74.9 (0.20) | 76.7 (0.07) | 85.4 (0.10) | 85.5 (0.05) | 72.5 (0.07) | 0.855 (0.85–0.86) | ||
| 3 years | 75.5 (0.18) | 76.2 (0.70) | 85.8 (0.07) | 85.9 (0.05) | 73.0 (0.07) | 0.858 (0.85–0.86) | ||||||
| 2. Age 70–79 years: | ||||||||||||
| A. Medical therapy | 1,302 | 73.9 (median) | 62.7 | 1 year | 62.1 (0.36) | 77.0 (0.15) | 83.0 (0.15) | 86.3 (0.07) | 74.9 (0.15) | 0.833 (0.82–0.84) | ||
| 3 years | 62.2 (0.41) | 76.7 (0.13) | 83.6 (0.15) | 86.6 (0.07) | 75.1 (0.15) | 0.835 (0.83–0.84) | ||||||
| B. CABG | 819 | 73.6 (median) | 77.2 | 1 year | 63.3 (0.46) | 80.5 (0.18) | 85.5 (0.52) | 88.6 (0.10) | 77.3 (0.18) | 0.844 (0.84–0.85) | ||
| 3 years | 62.9 (0.49) | 80.0 (0.18) | 85.9 (0.20) | 88.9 (0.10) | 77.4 (0.18) | 0.844 (0.84–0.85) | ||||||
| C. PCI | 819 | 73.9 (median) | 68.1 | 1 year | 63.2 (0.44) | 78.2 (0.18) | 84.0 (0.20) | 87.1 (0.10) | 75.8 (0.15) | 0.839 (0.83–0.85) | ||
| 3 years | 63.1 (0.46) | 77.8 (0.15) | 84.5 (0.20) | 87.4 (0.10) | 76.0 (0.18) | 0.840 (0.83–0.85) | ||||||
| 3. Age ≥80 years: | ||||||||||||
| A. Medical therapy | 220 | 82.4 (median) | 65.5 | 1 year | 51.9 (1.01) | 75.0 (0.33) | 79.9 (0.41) | 87.9 (0.20) | 73.5 (0.36) | 0.808 (0.80–0.82) | ||
| 3 years | 53.8 (1.27) | 76.8 (0.39) | 81.2 (0.44) | 88.3 (0.23) | 74.2 (0.39) | 0.815 (0.80–0.83) | ||||||
| B. CABG | 82 | 81.8 (median) | 74.4 | 1 year | 53.7 (1.56) | 78.1 (0.54) | 82.2 (0.62) | 89.6 (0.31) | 75.3 (0.54) | 0.818 (0.81–0.83) | ||
| 3 years | 54.2 (1.69) | 80.3 (0.52) | 83.8 (0.62) | 90.1 (0.33) | 76.2 (0.59) | 0.823 (0.81–0.83) | ||||||
| C. PC I | 137 | 82.1 (median) | 56.2 | 1 year | 51.9 (1.06) | 74.7 (0.41) | 79.3 (0.46) | 88.0 (0.23) | 72.9 (0.44) | 0.806 (0.80–0.82) | ||
| 3 years | 53.3 (1.25) | 76.9 (0.41) | 81.0 (0.46) | 88.7 (0.23) | 73.9 (0.44) | 0.813 (0.80–0.82) | ||||||
| Neil et al21 | (I) Age 21–81 years, with stable or unstable angina and a positive functional study for ischemia or undergoing angioplasty after a recent MI with target lesions that were potentially treatable by balloon angioplasty or a stent. | 1. Primary stent | 230 | 61.0 (median) | 75.0 | 6 months | 84.0 (1.51) | 82.0 (1.84) | 90.0 (1.18) | 88.0 (1.18) | 77.0 (1.45) | 0.887 (0.88–0.90) |
| 2. Optimal PTCA/provisional stent | 249 | 60.0 (median) | 72.0 | 6 months | 86.0 (1.33) | 83.0 (1.58) | 90.0 (1.07) | 91.0 (0.82) | 77.0 (1.33) | 0.892 (0.88–0.90) | ||
| de Quadros et al37 | (I) IHD. (E) Unsuccessful procedures (a residual stenosis >30% or TIMI flow 0/1 after stenting, or in-hospital major adverse cardiovascular events (death, MI, or urgent revascularization), severe cardiac disease other than IHD, ejection fraction <40%, severe neurologic disease, neoplasia, pregnancy, periprocedural hemodynamic instability, patient refusal. |
PCI | 110 | 62.8 | 68.0 | Baseline | 59.0 (1.71) | 30.0 (2.47) | 56.0 (2.38) | 80.0 (2.09) | 30.0 (2.09) | 0.704 (0.69–0.72) |
| 6 months | 79.0 (1.04) | 81.0 (2.66) | 86.0 (2.09) | 91.0 (1.33) | 64.0 (2.38) | 0.845 (0.83–0.86) | ||||||
| 1 year | 80.0 (1.00) | 90.0 (2.61) | 93.0 (1.30) | 94.0 (0.90) | 83.0 (2.21) | 0.897 (0.88–0.91) | ||||||
| Wong and Chair38 | (I) Chinese, ≥21 years old, no mental disorder, no prior PCI, understand and speak Cantonese, no severe medical illness. | PCI | 65 | 66.0 | 75.4 | Baseline | 67.6 (2.30) | 62.5 (3.62) | 74.2 (3.34) | 75.5 (1.51) | 55.8 (2.93) | 0.790 (0.77–0.81) |
| 1 month | 74.2 (3.24) | 65.5 (2.80) | 91.5 (0.76) | 85.6 (1.91) | 77.1 (2.75) | 0.873 (0.85–0.89) | ||||||
| Weintraub et al39 | (I) >70% stenosis in at least one major epicardial coronary artery with objective evidence of myocardial ischemia or >80% stenosis in at least one coronary artery and classic angina without provocative testing. | 1. PCI + OMT | 1,149 | 61.5 | 85.0 | Baseline | 66.0 (0.81) | 54.0 (1.06) | 68.0 (0.83) | 88.0 (0.48) | 51.0 (0.80) | 0.776 (0.77–0.79) |
| 1 month | 73.0 (0.82) | 81.0 (0.88) | 82.0 (0.77) | 92.0 (0.40) | 68.0 (0.81) | 0.839 (0.83–0.85) | ||||||
| 3 months | 76 (0.82) | 77 (0.95) | 85 (0.75) | 92 (0.41) | 73 (0.75) | 0.869 (0.86–0.87) | ||||||
| 6 months | 77.0 (0.77) | 76.0 (0.94) | 87.0 (0.66) | 92.0 (0.43) | 75.0 (0.73) | 0.869 (0.86–0.88) | ||||||
| 1 year | 75.0 (0.82) | 74.0 (0.92) | 87.0 (0.64) | 92.0 (0.40) | 76.0 (0.71) | 0.868 (0.86–0.88) | ||||||
| 2 years | 74 (0.88) | 73 (0.99) | 89 (0.65) | 92 (0.47) | 77 (0.80) | 0.871 (0.86–0.88) | ||||||
| 3 years | 74.0 (1.00) | 72.0 (1.16) | 89.0 (0.74) | 92.0 (0.49) | 79.0 (0.82) | 0.876 (0.87–0.88) | ||||||
| 2. OMT | 1,138 | 61.8 | 85.0 | Baseline | 66.0 (0.81) | 53.0 (1.02) | 69.0 (0.83) | 86.0 (0.51) | 51.0 (0.80) | 0.777 (0.77–0.79) | ||
| 1 month | 70.0 (0.82) | 73.0 (0.94) | 76.0 (0.80) | 88.0 (0.50) | 62.0 (0.80) | 0.813 (0.81–0.82) | ||||||
| 3 months | 72 (0.79) | 73.0 (0.92) | 80.0 (0.78) | 90.0 (0.47) | 68 (0.78) | 0.836 (0.83–0.84) | ||||||
| 6 months | 72.0 (0.83) | 73.0 (0.97) | 83.0 (0.75) | 90.0 (0.48) | 70.0 (0.75) | 0.844 (0.84–0.85) | ||||||
| 1 year | 73.0 (0.84) | 70.0 (0.98) | 84.0 (0.72) | 90.0 (0.48) | 73.0 (0.76) | 0.854 (0.85–0.86) | ||||||
| 2 years | 72 (0.89) | 69 (1.00) | 86.0 (0.70) | 92.0 (0.48) | 76 (0.81) | 0.862 (0.85–0.87) | ||||||
| 3 years | 74.0 (0.99) | 70.0 (1.16) | 88.0 (0.74) | 92.0 (0.45) | 77.0 (0.82) | 0.870 (0.86–0.88) | ||||||
| Agarwal et al27 | (I) Age ≥80 years, undergoing 1 or 2 vessel PCI. | PCI | 74 | 82.5 | 68.0 | Baseline | 24.4 (3.82) | 50.0 (6.61) | 45.8 (6.51) | 74.3 (3.85) | 38.8 (4.97) | 0.640 (0.61–0.67) |
| 6 months | 42.3 (2.55) | 72.4 (3.54) | 76.5 (3.67) | 83.7 (1.77) | 66.7 (3.04) | 0.769 (0.75–0.79) | ||||||
| 1 year | 41.4 (2.68) | 66.3 (4.01) | 73.5 (4.11) | 83.7 (2.08) | 62.3 (3.30) | 0.756 (0.73–0.78) | ||||||
| Lowe et al19 | (I) Severe stable angina (CCS class III or IV) despite maximum tolerated doses of at least two antianginal drugs, a left-ventricular ejection fraction of ≥30%, and reversible perfusion defects on the thallium stress test. | PCI | 11 | 59.0 (median) | 82.0 | Baseline | 38.0 (3.01) | 42.0 (6.03) | 40.0 (6.93) | 63.0 (6.33) | 21.0 (3.91) | 0.616 (0.59–0.65) |
| Pre-PCI | 37.0 (4.52) | 43.0 (8.74) | 49.0 (6.33) | 76.0 (6.33) | 38.0 (8.14) | 0.668 (0.62–0.71) | ||||||
| Post PCI | 36.0 (4.82) | 60.0 (9.64) | 61.0 (8.74) | 80.0 (6.33) | 45.0 (8.44) | 0.692 (0.64–0.74) | ||||||
| Ascione et al32 | (I) Conventional or off-pump CABG. (E) LVEF <30%, recent MI within 1 month (trial 1 of 2 only), history of supraventricular arrhythmia, previous CABG, renal or respiratory impairment, previous stroke, transient ischemic attack, coagulopathy, coronary disease in the branches of the circumflex artery distal to the first obtuse marginal branch (trial 1 of 2 only). |
1. Conventional CABG | 159 | 61.4 | 81.1 | 2–4 years | 75.2 (2.03) | 69.6 (2.66) | 86.8 (1.83) | 88.1 (1.72) | 74.8 (2.01) | 0.865 (0.85–0.88) |
| 2. Off-pump CABG | 169 | 63.1 | 83.4 | 2–4 years | 74.7 (1.88) | 66.3 (2.81) | 85.1 (1.79) | 88.6 (1.28) | 74.4 (1.79) | 0.862 (0.85–0.88) | ||
| Angelini et al33 | (I) Conventional or off-pump CABG. (E) LVEF <30%, recent MI within 1 month (trial 1 of 2 only), history of supraventricular arrhythmia, previous CABG, renal or respiratory impairment, previous stroke, transient ischemic attack, coagulopathy, coronary disease in the branches of the circumflex artery distal to the first obtuse marginal branch (trial 1 of 2 only). |
1. Conventional CABG | 149 | 60.9 | 86.6 | 6 years, 11 months (mean) | 72.4 (2.21) | 45.6 (3.77) | 88.8 (1.90) | 89.2 (1.96) | 74.0 (2.37) | 0.866 (0.85–0.88) |
| 2. Off-pump CABG | 150 | 62.1 | 84.7 | 6 years, 11 months (mean) | 75.0 (2.18) | 46.5 (3.67) | 89.6 (1.67) | 91.5 (1.55) | 77.0 (2.15) | 0.879 (0.86–0.90) | ||
| Karolak et al34 | (I) Conventional or off-pump CABG. (E) Reoperation, emergency CABG, concomitant major cardiac procedures, and EF <30%. |
1. Conventional CABG | 150 | 63.7 | 80.0 | 1 year | 80.0 (1.06) | 86.0 (1.95) | 91.0 (1.55) | 79.0 (1.46) | 81.0 (1.87) | 0.886 (0.87–0.90) |
| 2. Off-pump CABG | 149 | 62.2 | 81.2 | 1 year | 78.0 (1.88) | 86.0 (1.88) | 92.0 (1.14) | 79.0 (1.63) | 81.0 (1.72) | 0.883 (0.87–0.90) | ||
| Chaudhury et al35 | (I) Admitted to hospital for CABG, consented to participate in the study. | CABG | 30 | 60.0 | 90.0 | Baseline | 71.6 (1.44) | 9.8 (2.31) | 9.9 (1.62) | 37.8 (1.11) | 22.6 (0.89) | 0.653 (0.63–0.68) |
| 1 week | 53.1 (2.66) | 8.3 (2.20) | 5.8 (1.77) | 59.4 (0.76) | 36.1 (0.94) | 0.653 (0.63–0.68) | ||||||
| Wagner et al36 | (I) Veterans: non-emergent first time CABG surgery. (E) Single-vessel bypass with the internal mammary artery, concerns about arm functioning, creatinine level requiring hemodialysis or a level higher than 2.0 mg/dL, cardiogenic shock, allergic reactions to contrast material, robotic surgery, concomitant valve surgery,* concomitant Dor or Maze procedure,** no suitable radial target, participation in other research studies involving an intervention. |
1. Saphenous vein CABG | 367 | 62.0 | 99.0 | Baseline | 71.9 (0.99) | 37.9 (1.12) | 65.1 (1.15) | 91.2 (0.54) | 50.4 (1.02) | 0.788 (0.78–0.80) |
| 1 year | 86.1 (0.82) | 51.8 (0.64) | 92.5 (0.65) | 94.1 (0.54) | 83.3 (0.84) | 0.918 (0.91–0.93) | ||||||
| 2. Radial artery CABG | 366 | 61.0 | 99.0 | Baseline | 69.5 (1.05) | 37.0 (1.08) | 64.7 (1.16) | 92.0 (0.51) | 50.1 (1.07) | 0.783 (0.77–0.80) | ||
| 1 year | 83.3 (0.95) | 52.7 (0.67) | 91.7 (0.70) | 93.8 (0.57) | 83.6 (0.86) | 0.912 (0.90–0.92) | ||||||
| MacDonald et al28 | (I) Age ≥75 years, candidates for CABG. | CABG | 100 | 78.8 | 66.0 | Baseline | 40.2 (2.12) | 51.8 (3.41) | 53.8 (2.97) | 92.5 (1.49) | 40.3 (1.81) | 0.689 (0.67–0.71) |
| 3 months | 63.8 (2.44) | 92.7 (1.69) | 93.4 (1.45) | 93.3 (1.39) | 82.3 (2.05) | 0.863 (0.85–0.88) | ||||||
| Gelsomino et al23 | (I) Age ≥70 years, undergoing cardiac surgical procedures. | 1. Age ≥80 years | 1,142 | 83.0 | 49.0 | Baseline | 42.0 (4.42) | 32.0 (7.03) | 42.0 (8.59) | 52.0 (4.16) | 29.0 (3.12) | 0.643 (0.61–0.68) |
| 5 years, 9 months (median) | 77.0 (7.55) | 67.0 (6.51) | 79.0 (6.25) | 76.0 (5.20) | 76.0 (3.64) | 0.859 (0.82–0.90) | ||||||
| 2. Age 70–79 years | 1,213 | 72.0 | 68.9 | Baseline | 44.0 (5.72) | 35.0 (7.03) | 39.0 (7.03) | 51.0 (4.16) | 34.0 (3.12) | 0.655 (0.62–0.69) | ||
| 5 years, 9 months (median) | 83.0 (9.63) | 94.0 (4.42) | 92.0 (5.46) | 88.0 (5.98) | 93.0 (4.68) | 0.918 (0.87–0.96) | ||||||
| Fruitman et al29 | (I) Age ≥80 years, accepted for cardiac surgical procedures at a peer review conference. (E) Preoperative neurological diseases. |
CABG | 127 | 83.0 | 49.6 | 1 year, 4 months (mean) | 86.8 (2.84) | 94.4 (1.86) | 92.3 (2.14) | 89.3 (1.92) | 91.9 (1.84) | 0.928 (0.91–0.95) |
Notes: SAQ values include standard error, EQ-5D values include 95% confidence intervals.
*
Valve surgery is aortic or mitral valve replacement/repair.
**
Dor or Maze is for treatment of atrial fibrillation.
Abbreviations: I, inclusion criteria; E, exclusion criteria; IHD, ischemic heart disease; LVEF, left ventricular ejection fraction; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; CCS, Canadian Cardiovascular Society; PTCA, percutaneous transluminal coronary angioplasty; TIMI, Thrombolysis in Myocardial Infarction; OMT, optimal medical therapy; SAQ, Seattle Angina Questionnaire; PL, physical limitation; TS, treatment satisfaction; AF, angina frequency; AS, angina stability; DP, disease perception; EQ-5D, European Quality of Life-5 Dimensions.