Abstract 8999: Coronary Artery Revascularization Evaluation (CARE): Long term Outcomes Comparing Effectiveness of Revascularization Strategies in a Multi-center Community Hospital Registry
Background: Data from randomized clinical trials (RCT) comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, especially with diversity in the selection of drug eluting stents (DES), as well of on- vs. off-pump CABG. Registry data suggests that long-term follow-up is necessary in order to adequately compare the effectiveness of differing interventional strategies. A prospective registry of coronary revascularization (CR) by CABG--on- and off-pump--and PCI--bare metal (BMS) or DES--in a multicenter community hospital setting was accomplished. We hypothesize that the results of CR as performed in routine clinical practice may differ from the outcomes of RCT.
Methods and Results: All patients (N=4338; 3090 PCI, 1248 CABG) undergoing isolated CR in eight community-based hospitals were enrolled. Follow-up(63.5±27.9, median 79.7 months)was obtained by patient and/or physician contact, and the Social Security Death Index. STEMI and salvage patients were excluded (after exclusion, N=3871; 2690 PCI, 1181 CABG). All clinical decisions were based on treating physician preference. Propensity matching was used to achieve PCI and CABG patient groups of comparable clinical parameters and extent of coronary disease. (N=613 in each group) The incidence of initial major adverse cardiac events (MACE) for CABG vs. PCI was 29.2% vs. 41.8% (p<0.001). Analysis of stent sub-groups showed more event in BMS vs. DES (47.9 vs. 40.0%; p<0.001). Amongst propensity matched groups, the odds ratio for CABG to PCI was 0.69 (CI 0.56-0.85; p<0.001) for morality and 0.58 (CI 0.45-0.75;p<0.001) for any MACE (figure).
Conclusions: Long-term follow-up of a clinical registry which reflects current practice in the community hospital setting suggests that CABG, both on- and off- pump, may offer comparable patients with advanced coronary artery disease a survival advantage over PCI with either DES or BMS.
- © 2012 by American Heart Association, Inc.