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Future Research Needs for the Comparison of Percutaneous Coronary Interventions With Bypass Graft Surgery in Nonacute Coronary Artery Disease

Systematic Review

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Archived: The systematic review on which this report is based was assessed in May 2013 and some conclusions were considered out of date. As a result, the findings of this future research needs report may be used for research purposes, but should not be considered current.

This report is from AHRQ's series on Future Research Needs Projects.

Excerpt

Percutaneous coronary interventions (PCI) with or without stents and coronary artery bypass graft surgery (CABG) are the two broad categories of interventions for mechanical revascularization of atherosclerotic coronary arteries in patients with coronary artery disease (CAD). Generally, both approaches would be clinically relevant for patients with single-vessel disease of the proximal left anterior descending artery, most types of two-vessel disease, as well as for patients with three-vessel disease that is not particularly extensive. Because PCI and CABG differ in their procedural risk and their initial and downstream costs, assessing their comparative effectiveness and safety is of great interest.

PCI and CABG have already been compared in several randomized controlled trials (RCTs) and analyses of large clinical registries. The aim of this report is to identify needs for future research in the comparison between PCI and CABG. We use as a basis the 2007 comparative effectiveness review (CER) by the Stanford–University of California at San Francisco Evidence-based Practice Center (Stanford–UCSF EPC) that assessed PCI vs. CABG for coronary artery disease (hereafter we refer to the report as the "Stanford CER" for brevity). The CER summarized evidence published through 2006.