Abstract 11162: Multi-Vessel Percutaneous Coronary Stenting versus Multi-Vessel Coronary Bypass Grafting in the Emergent Setting: 11-Year Nationwide Propensity Score Matched Study
Background: Recently, using multivessel percutaneous coronary intervention with stenting (mPCI) has increased. While clinical trials evaluated the role of elective mPCI against multivessel Coronary Artery Bypass grafting (mCABG), little is known about efficacy of mPCI compared to mCABG in the urgent/emergency setting.
Methods: Using the Nationwide Inpatient Sample data from 1998-2008, we identified 25,023 patients who had emergent mPCI. These patients were matched against 24,975 emergent mCABG patients. “Multivessel” was defined as intervention on 3 or more coronary arteries. Patient demographics, hospital characteristics and Deyo Comorbidity score were used for risk-adjusted propensity score matching. Outcomes assessed were overall in-hospital mortality, complications, length of stay (LOS), disposition and inflation adjusted costs. The analysis was validated using regression models and evaluated on an intent-to-treat basis.
Results: The overall age was 64± 12 years and Deyo score was 2.8± 1.8. Overall, 28%(n =13,996) were females and 82% (41,047) were Caucasians. These characteristics were similar for both groups thereby ensuring a well-matched study cohort. In-hospital mortality rates were similar in both groups (3.28%, n = 818 vs. 3.22%, n = 808, P = 0.7). However, mPCI had fewer complications compared to mCABG (30%, n = 7645 vs. 39%, n = 9677, P <0.001) and was independently associated with 30% lower chance of complications (OR = 0.7, 95% CI = 0.67 to 0.72, P <0.001). mPCI was associated with a shorter LOS (5.5±7.4 d vs. 8.1±7.6 d, P <0.001) . Inflation adjusted hospitals charges were higher by $14,716 for the mPCI compared to mCABG group ( P<0.001). 30% (n = 7580) of mPCI required subsequent CABG during the same admission. Despite this, mPCI patients were three times more likely to go home (OR = 3.1; 95% CI 2.9 to 3.2; P < 0.001) compared to mCABG patients.
Conclusions: The use of mPCI as primary intervention in an urgent setting was associated with equivalent in-hospital mortality, lower complications and higher routine home discharges compared to mCABG. mPCI was, however, associated with higher conversion to CABG and hospital costs. In the urgent setting, multivessel disease should not preclude the use of mPCI as a primary modality if anatomy is feasible.
- © 2011 by American Heart Association, Inc.