Abstract 11800: Optimal Coronary Revascularization in Patients With Unstable Angina or Non-ST-Elevation Myocardial Infarction: 5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2
Background: SYNTAX trial revealed the long-term benefit of coronary artery bypass grafting (CABG) relative to percutaneous coronary intervention (PCI) using drug-eluting stent (DES) in patients with stable angina with complex coronary disease. However, long-term benefit of CABG relative to PCI in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) has not been well elucidated.
Methods and Results: We identified 673 patients with 3-vessel and/or left main disease with UA or NSTEMI among 15,939 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2 (PCI: n=425, CABG: n=238). Age was not different between the 2 groups (p=0.58). Rate of Killip class III or IV (pulmonary edema or cardiogenic shock) was not different between the 2 groups (14% vs. 11%, p=0.19). Number of treated lesion was higher in the CABG group (2.0±1.0 vs. 3.0±1.0, p<0.001). Pre-procedural SYNTAX score was significantly higher in the CABG group (26.8±10.8 vs. 32.2±10.5, p<0.001). Unadjusted 30-day mortality was 6.0% for PCI and 2.9% for CABG.
[Table] Five-year outcomes revealed that all-cause mortality after PCI was significantly higher than after CABG (hazard ratio [95% confidence interval]; 1.59 [1.15-2.21], p=0.005). The risk of composite of death, stroke, or myocardial infarction (MACCE) after PCI were also higher than after CABG (1.63 [1.23-2.16], p<0.001). In patients with 3-vessel disease without left main disease (n=465), the risks of death and MACCE after PCI were significantly higher than after CABG (1.59 [1.04-2.43], p=0.03 and 1.60 [1.10-2.34], p=0.01). Similarly the risks of death and MACCE after PCI were also higher than after CABG in patients with left main disease (n=208)
Conclusions: In patients with UA or NSTEMI, 5-year outcomes revealed that CABG relative to PCI reduced the risk of death, MACCE, and any revascularization in the DES era both in patients with 3-vessel and left main disease.
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
- Unstable angina
- Myocardial infarction, NSTEMI
- Follow-up studies
Author Disclosures: A. Marui: None. T. Kimura: Research Grant; Significant; Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. N. Nishiwaki: None. K. Mitsudo: None. T. Komiya: None. M. Hanyu: None. H. Shiomi: None. S. Tanaka: None. R. Sakata: None.
- © 2014 by American Heart Association, Inc.