Coronary artery bypass graft surgery versus drug-eluting stent implantation for high-surgical-risk patients with left main or multivessel coronary artery disease
OBJECTIVES: There are limited data comparing long-term outcomes of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with high surgical risk. We evaluated 5-year outcomes following CABG versus PCI with DES in 598 patients with left main or multivessel coronary artery disease (CAD) and a high surgical risk [EuroSCORE (European system for cardiac operative risk evaluation) > 6].
METHODS: Databases were merged from the BEST, PRECOMBAT and SYNTAX trials. The primary outcome was a major adverse cardiocerebral event (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke or repeat revascularization.
RESULTS: During 5-year follow-up, the rates of MACCE were 29.4% in the CABG group and 43.8% in the PCI group [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49-0.84; P = 0.001]. The MACCE was significantly better with CABG than with PCI in patients with high and intermediate SYNTAX scores (34.9% vs 46.3%, P = 0.039, and 29.7% vs 47.6%, P = 0.010, respectively), but comparable between the two groups in those with low SYNTAX scores. The rates of all-cause death and stroke were similar between the two groups. However, CABG was associated with fewer myocardial infarctions (HR, 0.50; 95% CI, 0.27-0.93; P = 0.027) and repeat revascularizations (HR, 0.32; 95% CI, 0.20-0.52; P < 0.001).
CONCLUSIONS: Among high surgical risk patients with left main or multivessel CAD, CABG compared to PCI with DES was associated with a lower rate of MACCE.
|Keywords||Coronary artery bypass graft surgery, Drug-eluting stents, EuroSCORE, Left main coronary artery disease, Multivessel disease|
|Persistent URL||dx.doi.org/10.1093/ejcts/ezw370, hdl.handle.net/1765/99853|
|Journal||European Journal of Cardio-Thoracic Surgery|
Chang, M, Lee, M.S, Ahn, J.-M. (Jung-Min), Cavalcante, R, Sotomi, Y, Onuma, Y, … Park, S.-J. (2017). Coronary artery bypass graft surgery versus drug-eluting stent implantation for high-surgical-risk patients with left main or multivessel coronary artery disease. European Journal of Cardio-Thoracic Surgery, 51(5), 943–949. doi:10.1093/ejcts/ezw370