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

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%; P_log-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 1.74 (95% CI, 1.41-2.16; P<.001).
• 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.