Abstract 11108: Improved Long-term Survival With Multiple Arterial Grafting Compared With Percutaneous Coronary Intervention or Conventional Coronary Artery Bypass Grafting: Analysis of 12,615 Patients With Stable Multivessel Disease
Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are frequently used for revascularization of multivessel coronary artery disease (MVCAD), but limited information is available comparing long-term survival of PCI versus multiple arterial CABG (MultArt).
Methods: We retrospectively reviewed 12,615 Mayo Clinic stable MVCAD patients treated with isolated primary CABG or PCI, from 1993 to 2009. CABG Patients (n=6,667) were stratified by number of arterial grafts into left internal mammary artery/saphenous veins (LIMA/SV; n=5,712) or MultArt (n=955) groups, and PCI patients (n=5,948) into balloon angioplasty only (BA; n=1,020), drug eluting stent (DES; n=1,686), and bare metal stent (BMS; n=3,242) groups.
Results: Long-term survival was greater for CABG versus PCI (15-year survival, 34% vs 23%, respectively [p<0.001]), and for MultArt vs LIMA/SV, BA, BMS (65% vs 31%, 30%, and 21%, respectively [p<0.001]), and DES (5-year survival, 95% vs 72%, respectively [p<0.001]). In propensity score-matched analysis CABG had improved survival compared with BA (15-year survival 40% vs 30%, p<0.001), BMS (39% vs 20%, p<0.001), and DES (5-year survival, 82% vs 72%, p<0.001). In multivariable analysis, CABG and MultArt were significantly associated with better survival versus PCI (HR, 0.64; 95%CI, 0.60-0.68; and HR, 0.41; 95% CI, 0.35-0.49; respectively [p< 0.001]). Interaction models showed that survival difference between CABG and PCI increased with the year of procedure (p<0.001).
Conclusions: In stable MVCAD patients undergoing isolated primary revascularization, CABG conferred long-term survival advantage compared with PCI. Survival was increased after multiple arterial CABG compared with LIMA/SV, BA, BMS and DES.
- © 2013 by American Heart Association, Inc.