Multivessel CAD: CABG confers survival benefit over PCI in real-world study

  • Panoulas VF & al.
  • Eur J Cardiothorac Surg
  • 11 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In real-world patients with multivessel coronary artery disease (CAD) treated with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with newer generation stents, the intermediate-term survival benefit was higher with CABG to that with PCI.

Why this matters

  • Findings suggest that in real-world patients with multivessel disease (MVD), CABG should be the preferred revascularisation modality.

Study design

  • 6383 patients with MVD undergoing CABG (n=4230; mean age, 66.4±10 years) or PCI (n=2153; mean age, 65.3±12.1 years) with second/third generation drug-eluting stents were included.
  • Mean follow-up period: 3.3 years.
  • Primary outcome: all-cause mortality.
  • Funding: None disclosed.

Key results

  • 5-year estimated survival was higher among patients who had CABG vs PCI (88% vs 78.3%; Plog-rank <.001>
  • CABG vs PCI was associated with significantly more in-hospital cerebral vascular accidents (1.1% vs 0.2%; P<.001>
  • The crude HR for PCI over CABG was 1.73 (95% CI, 1.49-2.01; P<.001 and the adjusted hr was ci p>
  • After adjustment, mortality rate was higher with PCI in patients with no previous CABG and stable CAD (HR, 2.11; 95% CI, 1.49-3.00; P<.001>
  • After propensity matching (CABG, n=653; PCI, n=653), PCI was associated with a higher adjusted HR for all-cause mortality (2.18; 95% CI, 1.54-3.1; P<.001>

Limitations

  • Selection bias.
  • Retrospective design and non-randomised nature of the study.

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