Major CABG trials in multivessel disease
| Study | Year | Comparison | Primary end point | Key findings |
|---|---|---|---|---|
| BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes)10 | 2009 | Revascularization (CABG or PCI) plus intensive medical therapy vs intensive medical therapy in patients with diabetes | All-cause mortality at 5 years | Revascularization with intensive medical therapy not superior to intensive medical therapy alone CABG stratum: lower prevalence of myocardial infarction (10% vs 17.6%) and MACCE (22.4% vs 30.5%), no significant difference in all-cause mortality (13.6% vs 16.4%) or cardiac death (8% vs 9%) PCI stratum: no significant difference in myocardial infarction, MACCE, all-cause mortality, or cardiac death |
| FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease)11 | 2012 | CABG vs PCI | All-cause mortality, nonfatal myocardial infarction, or nonfatal stroke | CABG superior to PCI: in CABG patients, lower 5-year primary composite end point (18.7% vs 26.6%), lower prevalence of myocardial infarction (6.0% vs 13.9%) and all-cause mortality (10.9% vs 16.3%), higher prevalence of stroke (5.2% vs 2.4%) |
| SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery)12 | 2013 | CABG vs PCI (paclitaxel-eluting stents) | Composite MACCE (all-cause mortality, stroke, myocardial infarction, and repeat revascularization) | PCI inferior and not noninferior to CABG Lower 5-year MACCE (26.9% vs 37.3%); lower prevalence of cardiac death (5.3% vs 9%), myocardial infarction (3.8% vs 9.7%), and repeat revascularization (13.7% vs 25.9%); no significant difference in all-cause mortality (11.4% vs 13.9%) or stroke (3.7% vs 2.4%) for CABG and PCI, respectively |
| BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease)13 | 2015 | CABG vs PCI (everolimus-eluting stents) | Composite of death, myocardial infarction, target-vessel revascularization | No significant difference in primary composite end point at 2 years (PCI 11% vs CABG 7.9%) At longer-term follow-up (median 4.6 years), PCI had significantly higher primary end point (15.3% vs 10.6%) compared with CABG owing to repeat revascularization and spontaneous myocardial infarction |
| STICH (Surgical Treatment for Ischemic Heart Failure) and STICHES (STICH Extension Study)9 | 2016 | CABG plus medical therapy vs medical therapy alone in patients with left ventricular ejection fraction ≤ 35% | All-cause mortality | No significant difference in primary end point over 6 years; however, CABG with medical therapy resulted in significant improvement in long-term all-cause mortality out to 10 years compared with medical therapy alone (58.9% vs 66.1%) Cardiovascular mortality and morbidity were lower with CABG in both studies |
| FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)14 | 2021 | Fractional flow reserve–guided PCI vs CABG in triple-vessel disease | MACCE (death from any cause, myocardial infarction, stroke, or repeat revascularization) | Fractional flow reserve–guided PCI not consistent with noninferiority to CABG: higher MACCE in fractional flow reserve–guided PCI arm compared with CABG (10.6% vs 6.9%) at 1 year |
CABG = coronary artery bypass grafting; MACCE = major adverse cardiac or cerebrovascular events; PCI = percutaneous coronary intervention