Abstract
Background/Aim: Medical therapy (MT) and coronary artery bypass graft (CABG) are valuable treatment options for patients with ischemic heart diseases (IHD). However, their negative outcomes in the long-term are poorly investigated. Therefore, we conducted this meta-analysis to determine the long-term effects of both interventions. Methods: Till Nov 27, 2020, nine databases were searched for original articles investigating MT versus CABG in patients with IHD. Primary outcomes included mortality, survival, revascularization/additional treatment, event-free survival (incidence of cardiovascular (CV) mortality, myocardial infarction (MI), or refractory angina), cerebrovascular accidents (CVA), and acute MI. Secondary outcomes included imaging findings, such as left ventricular ejection fraction (LVEF). Cochrane’s revised tool (Version II) and ROBINS-I tool were used to assess the risk of bias of randomized and non-randomized intervention studies, respectively. Results: Fifteen studies were included in the systematic review, while twelve studies (34350 patients) were analyzed. CABG was associated with a significant reduction in all-cause mortality (OR=0.61; 95%CI: 0.45-0.83) and significant improvement in survival (OR=2.45; 95%CI: 1.61-3.73). The risk of acute MI (OR=0.44; 95%CI: 0.23-0.85) and the need for revascularization/additional treatment were significantly lower in the CABG group. No significant differences were noted as regards CV mortality (OR=0.64; 95%CI: 0.34-1.17), CVA (OR=1.45; 95%CI: 0.56-3.75), event-free survival (OR=0.86; 95%CI: 0.22-3.39), and LVEF (OR=-0.21; 95%CI: -1.48-1.6). Eleven studies had low risk, and four studies had a high risk of bias. Conclusions: Compared to medical therapy alone, CABG offers better long-term outcomes in terms of fewer mortality rates, higher survival rates, and limited need for revascularization or additional treatment.
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