Abstract 2118: What is the Preferred Strategy for Revascularization of Patients With Multivessel Disease: Percutaneous Coronary Intervention with Drug-eluting Stents or Coronary Artery Bypass Surgery?
Background: The advent of drug-eluting stents (DES) with resulting reduction in restenosis and need for repeat revascularization has turned percutaneous coronary intervention (PCI) into an attractive revascularization strategy for patients with multivessel disease. This study compares the outcomes of PCI vs CABG for these patients (pts) in the era of DES.
Methods: The clinical outcomes of 741 pts who underwent 2 or 3 vessel PCI (if staged 2-vessel (2v) PCI was performed during one hospitalization and 3-vessel (3v) PCI within 6 weeks of initial DES implantation) were compared with 446 pts who underwent CABG for 2v and 3v CAD. Clinical data and outcomes were then extracted from pre-existing surgical and PCI databases and analyzed. All outcomes were adjudicated by chart review. The composite endpoint of 1 year TVR-MACE (death, stroke, Q-wave MI, and target vessel failure (TVF)) was compared between the 2 groups. TVF was defined as target vessel revascularization (TVR) for the PCI cohort and graft failure or TVR for the CABG group.
Results: Baseline characteristics were similar among groups except for higher rates of renal insufficiency, prior CABG, and presentation with unstable angina in the PCI group while prior history of (h/o) CAD was higher in the CABG group (Table⇓). At 1 year, the rates of TVR-MACE were lower with CABG vs PCI (13.2% vs 22.2%, p=0.03 and 8.2% vs 30.0%, p<0.001) for 2v and 3v CAD, respectively. While the adjusted outcomes showed superiority of CABG over PCI only for 3v CAD with a trend for the 2v CAD pts (odds ratio for CABG being superior 4.03 (95% CI 2.08–7.81, p<0.001) for 3v CAD and 1.81 (95% CI 0.98–3.36, p=0.06) for 2v).
Conclusions: For unselected pts with multivessel disease who require revascularization, CABG shows superiority over PCI with the use of DES in terms of repeat revascularization and overall mortality especially for 3v intervention. These results may be attributed to the high rate of diabetes in this cohort.