Abstract 12752: Optimal Myocardial Revascularization in the Era of Off-pump Coronary Surgery/Drug-eluting Stent: Insights from the CREDO-Kyoto Registry Cohort 2
Background: The current increase of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) or off-pump CABG (OPCAB) may result in major changes in power relationship in myocardial revascularization. Particularly in Japan, OPCAB is employed more frequently (>60%) than it is in the US or Europe, which may enable a more reliable comparison between PCI with DES and OPCAB using Japanese data.
Methods and Results: Among the 15,263 patients enrolled in the CREDO-Kyoto Registry Cohort 2 (a registry of first-time PCI and CABG patients in Japan), 3986 patients with triple-vessel and/or left main disease were enrolled into the present study: 2197 patients received PCI (DES=73%) and 1796 did CABG (OPCAB=64%). Unadjusted all-cause mortality after PCI at 4 years was higher than CABG (15.7% vs. 12.4%, p<0.01). Multivariate analysis showed that adjusted all-cause and cardiac mortality after PCI were higher than CABG (hazard ratio [95% confidence interval]: 1.49 [1.19-1.87], p<0.01 and 1.72 [1.27-2.31], p<0.01). Similarly, adjusted incidence of myocardial infarction (MI) and target-lesion revascularization (TLR) after PCI were higher than CABG (2.07 [1.44-2.98], p<0.01 and 3.50 [2.86-4.27], p<0.01). Adjusted incidence of stroke was similar between PCI and CABG (1.09 [0.82-1.46], p=0.54). Next, we divided CABG into OPCAB (n=1141) and conventional on-pump CABG (CCAB, n=655) and compared [Table]. Adjusted all-cause mortality, cardiac mortality, MI rate, TLR rate, composite event (cardiovascular death/stroke/MI) after PCI was higher than OPCAB. The incidence of stroke was similar between PCI and OPCAB. On the other hand, the incidences of all these outcomes were similar between CCAB and OPCAB.
Conclusions: In patients with triple-vessel and/or left main disease, CABG is associated with better long-term survival and cardiovascular-event-free outcomes than PCI using DES. Overall outcomes are similar between CCAB and OPCAB.
- © 2012 by American Heart Association, Inc.