Abstract 2121: Surgical Revascularization is Associated with Improved Long-term Outcomes Compared to Percutaneous Stenting in Patients with Multivessel Coronary Artery Disease
Background: Coronary artery bypass surgery (CABG) and percutaneous coronary intervention with stenting (PCI-S) are both safe and effective approaches for revascularization in patients with coronary artery disease. Although CABG has traditionally been considered to have more favorable long-term outcomes over PCI in multivessel disease, there is little information comparing the two methods for typical “real-world” patients in the modern PCI-S era.
Methods: Patients were studied if they were revascularized by CABG or PCI-S, had at least 5 years of follow-up, and had ≥2-vessel disease. Patients were followed for an average of 7±3.2 years for incidence of death and major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and repeat revascularization. Multivariate regression models were used to correct for standard cardiac risk factors including age, sex, hyperlipidemia, DM, family history of CAD, smoking history, hypertension, heart failure, and renal failure. Subgroup analysis was also performed based on the presence of diabetes.
Results: A total of 2,512 patients (CABG=1989, PCI-S=523) were included. Age averaged 66.2±10.7 years, 76% were male, and 26% were diabetic. Over the follow-up, 824 (36%) died. Multivariate risk favored CABG over PCI-S for both death (hazard ratio [HR] =0.56, p<0.0001) and MACE (multivariate HR=0.46, p<0.0001). When stratified by diabetic status, there was a similar advantage to CABG in both groups:
Diabetics (CABG=545, PCI-S=107): death HR=0.57, p=0.001 and MACE HR=0.50, p<0.0001;
Non-diabetics: death HR=0.56, p<0.0001 and MACE HR=0.42, p<0.0001.
Conclusions: In this large real-world observational study of patients undergoing revascularization for multivessel CAD, there appears to be a long-term benefit, in relationship to both death and MACE, from CABG over PCI-S regardless of diabetic status. Although limited by its retrospective and observational nature, this study demonstrates that CABG remains an excellent option for revascularization in patients with multi-vessel CAD.