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(Circulation. 2008;118:S199-S209.)
© 2008 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Long-Term Outcomes of Coronary-Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease in the Bare-Metal Stent Era

Takeshi Kimura, MD; Takeshi Morimoto, MD; Yutaka Furukawa, MD; Yoshihisa Nakagawa, MD; Satoshi Shizuta, MD; Natsuhiko Ehara, MD; Ryoji Taniguchi, MD; Takahiro Doi, MD; Kei Nishiyama, MD; Neiko Ozasa, MD; Naritatsu Saito, MD; Kozo Hoshino, MD; Hirokazu Mitsuoka, MD; Mitsuru Abe, MD; Masanao Toma, MD; Toshihiro Tamura, MD; Yoshisumi Haruna, MD; Yukiko Imai, MpH; Satoshi Teramukai, PhD; Masanori Fukushima, MD; Toru Kita, MD

From the Department of Cardiovascular of Medicine (T. Kimura, H.M., T. Kita) and the Center for Medical Education (T.M.), Graduate School of Medicine, Kyoto University; the Division of Cardiology (Y.F., S.S., T.D., N.O., N.S., M.T., T.T.), Kyoto University Hospital; the Division of Cardiology (Y.N.), Tenri Hospital; the Division of Cardiology (N.E.), Kobe City Medical Center General Hospital; the Division of Cardiology (R.T.), Hyogo Prefectural Amagasaki Hospital; Emergency Medicine (K.N.), Kyoto University Hospital the Division of Cardiology (K.H.), Nagai Hospital; the Division of Cardiology (M.A.), National Cardiovascular Center; the Division of Cardiology (Y.H.), Keihanna Hospital; Translational Research Informatics Center (Y.I.), Foundation for Biomedical Research Innovation; and the Translational Research Center (S.T., M.F.), Kyoto University Hospital, Japan.

Correspondence to Takeshi Kimura, Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. E-mail taketaka{at}kuhp.kyoto-u.ac.jp

Background— Observational registries comparing coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) have reported long-term survival results that are discordant with those of randomized trials.

Methods and Results— We conducted a multicenter study in Japan enrolling consecutive patients undergoing first CABG or PCI between January 2000 and December 2002. Among 9877 patients enrolled, 5420 (PCI: 3712, CABG: 1708) had multivessel disease without left main involvement. Because age is an important determinant when choosing revascularization strategies, survival analysis was stratified by either age 75 or <75 years. Analyses were also performed in other relevant subgroups. Median follow-up interval was 1284 days with 95% follow-up rate at 2 years. At 3 years, unadjusted survival rates were 91.7% and 89.6% in the CABG and PCI groups, respectively (log rank P=0.26). After adjustment for baseline characteristics, survival outcome tended to be better after CABG (hazard ratio for death after PCI versus CABG [HR], 95% confidence interval [CI]: 1.23 [0.99-1.53], P=0.06). Adjusted survival outcomes also tended to be better for CABG among elderly patients (HR [95%CI]: 1.37 [0.98-1.92] P=0.07), but not among nonelderly patients (HR [95% CI]: 1.09 [0.82-1.46], P=0.55). Unadjusted and adjusted survival outcome for CABG and PCI were not significantly different in any subgroups when elderly patients were excluded from analysis.

Conclusions— In the CREDO-Kyoto registry, survival outcomes among patients <75 years of age were similar after PCI and CABG, a result that is consistent with those of randomized trials.

Key Words: coronary artery disease • percutaneous coronary intervention • coronary stent • coronary artery bypass graft (CABG) surgery • long-term outcome