{
  "abstract": "Background Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes.Methods A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores.Results 10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68–1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79–1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71–1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models.Conclusions This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains.PROSPERO registration number CRD42024541215.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands"
      ],
      "name": "Michal J Kawczynski"
    },
    {
      "affiliations": [
        "Università Degli Studi Di Milano, Milan, Italy",
        "IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy",
        "Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Fabio Barili, M.D. Ph.D. FESC"
    },
    {
      "affiliations": [
        "McGill University, Montreal, Quebec, Canada"
      ],
      "name": "James M Brophy"
    },
    {
      "affiliations": [
        "Cardiology Division, Pisa University Hospital, Pisa, Italy"
      ],
      "name": "Raffaele De Caterina"
    },
    {
      "affiliations": [
        "Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy",
        "Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy"
      ],
      "name": "Giuseppe Biondi Zoccai"
    },
    {
      "affiliations": [
        "Department of Thoracic and Cardiovascular Surgery, University Hospital Centre Rennes, Rennes, France"
      ],
      "name": "Amedeo Anselmi"
    },
    {
      "affiliations": [
        "VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "William E Boden"
    },
    {
      "affiliations": [
        "Università Degli Studi Di Milano, Milan, Italy"
      ],
      "name": "Alessandro Parolari"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands"
      ],
      "name": "Samuel Heuts"
    },
    {
      "affiliations": [],
      "name": "on behalf of the INTEGRITTY initiative"
    }
  ],
  "title": "Revascularisation strategies for non-acute myocardial ischaemic syndromes",
  "uid": "bf84d46a-4ae7-5cb1-bbd1-48cea753085d"
}