Use of coronary artery bypass graft surgery and percutaneous coronary intervention and associated outcomes in the ISCHEMIA trial

White, HD; O'Brien, SM; Boden, WE; Fremes, SE; Bangalore, S; Reynolds, HR; Stone, GW; Ali, ZA; Parakh, N; Lopez-Sendon, JL; Wang, Y; Chen, YQ; Mark, DB; Chaitman, BR; Spertus, JA; Maron, DJ; Hochman, JS; ISCHEMIA Research Group.

doi:10.1016/j.ahj.2025.05.009

Use of coronary artery bypass graft surgery and percutaneous coronary intervention and associated outcomes in the ISCHEMIA trial

Am Heart JPublished 20 May 2025Secondary analysis of the ISCHEMIA randomised trial

Primary result · Adjusted primary event rate, comparative cohort (n = 1,203; 385 CABG, 818 PCI)ResultDifference 1.3% 95% CI −4.9% to 7.7%

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Authors' conclusion

There was no statistical evidence of a difference between PCI and CABG in the intermediate SYNTAX group but the CIs are broad, reflecting uncertainty.

Study context

Population: Patients with stable coronary disease in the invasive arm of ISCHEMIA who underwent CABG or PCI within 180 days of randomisationdescriptive cohort
Participants: 1,935 patients

Comparison: CABG vs PCI
CABGn = 485
PCIn = 1,450reference
Primary endpoint: CV death, MI, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest
Follow-up: 4 years

Methodological detailsobservational comparison of CABG vs PCI, adjusted analysis

Observational comparison of CABG vs PCI
Adjusted analysis

Primary result

As reported in the abstract

Adjusted primary event rate, comparative cohort (n = 1,203; 385 CABG, 818 PCI)

Difference

1.3%

95% CI −4.9% to 7.7%

By group

CABG14.5%

PCI13.2%

CABGvs PCI

difference 1.3% (95% CI −4.9% to 7.7%)

Further findings

Outcome	CABG	PCI	← Lower with CABG ←→ Higher with CABG →	Difference (95% CI)
Adjusted primary event rate, intermediate SYNTAX (23-32) group (n = 346; 163 CABG, 183 PCI) · 4 yearsAdjusted	10.6%	18.3%	−20−10010	−7.6% (−16.1% to 0.9%)
			−20−10010Difference (linear scale)

Outcome	CABG	PCI	P value
SYNTAX score, descriptive cohort	27.3 ± 11.0	15.3 ± 8.6	P < 0.0001

Revascularization method by SYNTAX score

Low SYNTAX scores: underwent PCI: 87.1%
High SYNTAX scores: underwent CABG: 72.6%

Original publication

Use of coronary artery bypass graft surgery and percutaneous coronary intervention and associated outcomes in the ISCHEMIA trial. Am Heart J. Published 20 May 2025. doi:10.1016/j.ahj.2025.05.009

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