Abstract 4678: Surgical versus Percutaneous Revascularization for the Treatment of Patients With Multivessel Disease in the Setting of Acute Coronary Syndromes: Analysis From the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) Trial
Objective: We sought to evaluate outcomes of moderate- to high-risk acute coronary syndrome (ACS) patients managed with early invasive strategy using percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG).
Methods: Among a total of 13,819 moderate-to high-risk ACS patients in the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial, 5,772 pts had multivessel disease and were triaged to either PCI (n=4,423) or CABG (n=1,349). Propensity score matching was applied to adjust for differences in baseline clinical characteristics, cardiac biomarker elevation, St-segment deviation, TIMI risk score, extent of coronary disease, involvement of left main artery and LVEF. Matching yielded 2 groups (588 patients each) that were used to compare the two revascularization modalities.
Results: The majority of patients in the PCI group (70.2%) received ≥1 drug-eluting stents. Main outcomes are summarized in the table⇓. Surgical revascularization was associated with higher rates of myocardial infarction and a trend toward higher rates of composite of MACE or CVA/TIA at 30 days, while percutaneous revascularization was associated with higher rates of unplanned revascularization both at 30 days and at 1 year.
Conclusion: In this matched comparison from the ACUITY trial, moderate- to high-risk patients with ACS and multivessel disease had lower rate of early myocardial infarctions but higher need for early and late repeat revascularizations when treated with PCI compared to CABG.