Abstract 2294: Comparison Of Mid-term Outcome In Unselected Population Of Patients With Three Vessel And/or Left Main Stem Disease Undergoing Percutaneous Coronary Intervention Or Coronary Artery Bypass Graft Surgery
Both coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are effective treatment modalities for patients with coronary artery disease. However, the optimal treatment for patients with multivessel disease has recently become a matter of debate. To date, there are no prospective randomised trials comparing these two options in patients with three vessel disease. In this study, we assessed the outcomes of major adverse cardiac and cerebrovascular events and death in a “real-world”, unselected cohort of patients with three vessel and/or left main stem disease undergoing contemporary coronary revascularisation in our hospital. Ongoing prospective data collection of 646 consecutive patients with three vessel and/or left main stem disease, admitted for coronary artery bypass graft surgery or percutaneous coronary intervention, was carried out. Demographic, clinical, angiographic, and procedural data were collected. The incidence of death and major adverse cardiac and cerebrovascular events were evaluated at 6 months and one year after the index procedure by conducting telephone interviews. Subgroup analyses were performed. Our results showed the superiority of CABG over PCI in relationship to both death and major adverse cardiac events. Mortality at six months was significantly higher in PCI group compared to CABG group (5.3% vs 2.2%, respectively, p = 0.025). One year mortality was still higher in PCI group but there was no significant difference (6.7% versus 5.1%, respectively, p = 0.39). Myocardial infarction occurred only in PCI group (3.3% vs 0%, p = 0.0027). Repeat revascularisation rate was significantly higher in PCI group (14.2% vs 0.7 %, p < 0.001). CABG was better in relieving anginal symptoms: 3.7% of CABG patients had recurrence of angina compared to 21.5% in PCI group (p < 0.001). A similar advantage was found at one year follow-up. Diabetic subgroup analysis also favoured CABG regarding major adverse cardiac events. Compared with PCI, CABG resulted in better mid-term survival and lower incidence of major adverse cardiac events regardless of diabetic status or other risk factors.