Abstract 13031: Survival with PCI versus CABG in Multivessel Coronary Disease in the Moderan Era of Revascularization
Background: Although SYNTAX (n=1,800) reported equivalent 2 year survival for select patients with left main or 3VD randomized to PCI v CABG, a broader range of patients with multivessel CAD face the choice of PCI v CABG. We assessed 4.5 year survival rates from our regional registry of consecutive procedures for a cohort of BARI-like patients with multivessel CAD (n=7,180) who chose PCI or CABG.
Methods: From our Northern New England relational registries of PCI and CABG procedures we identified patients with 2VD or 3VD (excluding left main disease) undergoing a first, non-emergent PCI (n-3,334, 88% DES) or CABG (n=3,846) from 10/2003–2007. Survival was obtained by linkage to SSA death index. Cox proportional-hazards models and propensity matching were used to adjust for differences in age, sex, comorbidities, CHF, recent MI, priority, EF, anatomy.
Results: PCI patients were slightly older and more likely male. CABG patients had more diabetes, PVD, EFs <40%, and 3VD (57.5% CABG v 21.1% PCI). Completeness of revascularization was greater for CABG than PCI (100% v 48.9%). Inhospital mortality was 2.0% for CABG and 0.3% for PCI (p<0.01). However, survival at 4.5 years (Figure) was better for CABG than PCI (86.7% v 83.9% adjHR 0.69, 95%CI 0.57–0.83). This was true for patients with 3VD (85.7% v 80.3% adjHR 0.53, 95%CI 0.40–0.70) but not for those with 2VD (86.7% v 86.6% adjHR 0.83, 95%CI 0.65–1.05).
Conclusions: In our real world practice, the choice of PCI v CABG results in comparable survival for patients with 2VD. In contrast, patients with 3VD have better survival with CABG. To what extent this is a consequence of patients with a high SYNTAX score undergoing PCI is unknown.
- Cardiac surgery
- Percutaneous coronary intervention
- Coronary heart disease
- Health services research
- © 2010 by American Heart Association, Inc.