PCI vs. CABG for Multivessel CAD | Journal Scan
What are the outcomes with coronary artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) with the use of everolimus-eluting stents, in patients who had multivessel coronary artery disease (CAD)?
The investigators compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents in an observational registry study. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.
Among the 34,819 eligible patients, 9,223 patients who underwent PCI with everolimus-eluting stents and 9,223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93-1.17; p = 0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29-1.77; p < 0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14-2.58; p < 0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; p < 0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization, but was significant among those with incomplete revascularization (p = 0.02 for interaction).
The authors concluded that the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG in a contemporary registry.
In this contemporary cohort of patients with multivessel CAD, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. However, PCI was associated with a higher risk of myocardial infarction (mainly among patients who had incomplete revascularization) and repeat revascularization, whereas CABG was associated with an increased risk of stroke. Short-term results favored PCI with lower risks of stroke, and longer-term results favored CABG with lower repeat revascularization and MI. There appears to be tradeoffs between PCI and CABG strategies that need to be discussed by the multidisciplinary heart team with patients as part of the shared decision-making process and taking into account the completeness of revascularization that can be offered with PCI.
Keywords: Coronary Artery Disease, Percutaneous Coronary Intervention, Coronary Artery Bypass, Stents, Drug-Eluting Stents, Myocardial Infarction, Stroke, Risk, Propensity Score, Registries, ACC Annual Scientific Session, Mortality
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