Abstract 3140: Favorable Long-term Survival In Patients Undergoing Multivessel PCI Compared To Predicted Prognosis Using The Logistic EuroScore
Background: Despite various randomized trials, the debate is still ongoing whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is the best treatment strategy for multivessel coronary artery disease (MVD). The EuroScore has been established to assess short-term risk in patients undergoing CABG. The current analysis of a “daily life” patient series aims to assess value of the EuroScore to determine in-hospital and long-term prognosis also after PCI.
Methods: We analyzed 514 consecutive patients (pts) who underwent PCI in at least two main vessels at our center. All pts were treated between August 2000 and December 2005. Expected in-hospital mortality was calculated using the logistic EuroScore and compared to the observed survival-rate.
Results: The pts were suffering from 2.5±0.6 diseased vessels, while 2.2±0.4 vessels were stented (22% drug eluting stents; 76% complete revascularization rate). 62% of pts were treated for acute coronary syndrome (27% STEMI; 20% NSTEMI), 38% had stable MVD. As expected, the logistic EuroScore was significantly higher in unstable compared to stable pts (12.6±14.8% vs 3.6±2.7%; p<0.001). Throughout all subgroups, the observed intra-hospital mortality was far lower than the logistic EuroScore (STEMI 9% vs 16±18%; NSTEMI 3% vs 14±13%; no infarction 1% vs 4±4%). ROC analysis determined a logistic EuroScore of less than 4.2 as an ideal cut-off to identify patients with low mortality during long-term follow up (AUC 0.782; p<0.001). These pts experienced 1.7% long term overall mortality (mean follow-up 956 d) compared to a projected intra-hospital mortality of 2.5±1.0%. Cox regression analysis identified an elevated logistic EUROScore (HR 3.3, 95% CI 1.1–10.0) and diabetes (HR 3.3, 95% CI 1.6 –7.7) as the only independent predictors of long-term mortality.
Conclusion: The intra-hospital mortality of patients undergoing multivessel PCI is much lower than the predicted mortality of CABG. Both diabetes and logistic EuroScore were the strongest independent predictors of long-term mortality. Patients with a logistic EuroScore below 4.21 experienced an excellent long-term prognosis, suggesting that multivessel PCI, especially in this patient subset, is a reasonable alternative to CABG.