Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center
Background: Clinical equipoise between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) in the treatment of complex coronary artery disease (CAD), including unprotected left main coronary artery (LMCA) and/or three-vessel disease (3VD), remains debatable....
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Heart Views |
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| Online Access: | http://www.heartviews.org/article.asp?issn=1995-705X;year=2023;volume=24;issue=3;spage=141;epage=147;aulast=Hesse |
| _version_ | 1797738833896275968 |
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| author | Kerrick Hesse Mohaned Egred Azfar Zaman Mohammad Alkhalil Mohamed Farag |
| author_facet | Kerrick Hesse Mohaned Egred Azfar Zaman Mohammad Alkhalil Mohamed Farag |
| author_sort | Kerrick Hesse |
| collection | DOAJ |
| description | Background: Clinical equipoise between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) in the treatment of complex coronary artery disease (CAD), including unprotected left main coronary artery (LMCA) and/or three-vessel disease (3VD), remains debatable.
Methods: A retrospective analysis of an unselected cohort undergoing contemporary PCI versus CABG at a large center in 2015. Patients who received nonemergent treatment of unprotected LMCA and/or 3VD were included. The primary study endpoint was all-cause mortality at 5 years. Secondary endpoints included a composite of all-cause mortality, spontaneous myocardial infarction (MI), or ischemia-driven repeat revascularization at 30 days and 1 year.
Results: Four hundred and thirty patients met the inclusion criteria, 225 had PCI, and 205 had CABG. PCI patients were older with frequent LMCA involvement and higher EuroSCORE yet they had a fourfold shorter in-hospital stay compared to CABG patients. At 5 years, there was no significant difference in the primary endpoint between CABG and PCI (adjusted Hazard ratios 0.68, 95% confidence interval: 0.38–1.22, P = 0.19). Likewise, there was no significant difference in the incidence of the secondary composite endpoint or its components at 30 days or 1 year. A propensity score-matched analysis in 220 patients revealed similar outcomes.
Conclusions: In real-world long-term contemporary data, survival after PCI was comparable to CABG at 5 years in patients with unprotected LMCA and/or 3VD. At 1 year, the incidence of spontaneous MI and ischemia-driven repeat revascularization did not differ between the two cohorts. The mode of revascularization in these complex patients should be guided by the heart team. |
| first_indexed | 2024-03-12T13:49:32Z |
| format | Article |
| id | doaj.art-e70e907c10a740e4b812cdbaca4489ae |
| institution | Directory Open Access Journal |
| issn | 1995-705X |
| language | English |
| last_indexed | 2024-03-12T13:49:32Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Heart Views |
| spelling | doaj.art-e70e907c10a740e4b812cdbaca4489ae2023-08-23T07:29:56ZengWolters Kluwer Medknow PublicationsHeart Views1995-705X2023-01-0124314114710.4103/heartviews.heartviews_116_22Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume centerKerrick HesseMohaned EgredAzfar ZamanMohammad AlkhalilMohamed FaragBackground: Clinical equipoise between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) in the treatment of complex coronary artery disease (CAD), including unprotected left main coronary artery (LMCA) and/or three-vessel disease (3VD), remains debatable. Methods: A retrospective analysis of an unselected cohort undergoing contemporary PCI versus CABG at a large center in 2015. Patients who received nonemergent treatment of unprotected LMCA and/or 3VD were included. The primary study endpoint was all-cause mortality at 5 years. Secondary endpoints included a composite of all-cause mortality, spontaneous myocardial infarction (MI), or ischemia-driven repeat revascularization at 30 days and 1 year. Results: Four hundred and thirty patients met the inclusion criteria, 225 had PCI, and 205 had CABG. PCI patients were older with frequent LMCA involvement and higher EuroSCORE yet they had a fourfold shorter in-hospital stay compared to CABG patients. At 5 years, there was no significant difference in the primary endpoint between CABG and PCI (adjusted Hazard ratios 0.68, 95% confidence interval: 0.38–1.22, P = 0.19). Likewise, there was no significant difference in the incidence of the secondary composite endpoint or its components at 30 days or 1 year. A propensity score-matched analysis in 220 patients revealed similar outcomes. Conclusions: In real-world long-term contemporary data, survival after PCI was comparable to CABG at 5 years in patients with unprotected LMCA and/or 3VD. At 1 year, the incidence of spontaneous MI and ischemia-driven repeat revascularization did not differ between the two cohorts. The mode of revascularization in these complex patients should be guided by the heart team.http://www.heartviews.org/article.asp?issn=1995-705X;year=2023;volume=24;issue=3;spage=141;epage=147;aulast=Hessecoronary artery bypass grafting surgerycoronary artery diseasemyocardial infarctionoutcomepercutaneous coronary interventionrevascularization |
| spellingShingle | Kerrick Hesse Mohaned Egred Azfar Zaman Mohammad Alkhalil Mohamed Farag Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center Heart Views coronary artery bypass grafting surgery coronary artery disease myocardial infarction outcome percutaneous coronary intervention revascularization |
| title | Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center |
| title_full | Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center |
| title_fullStr | Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center |
| title_full_unstemmed | Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center |
| title_short | Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center |
| title_sort | percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease long term clinical outcomes from a high volume center |
| topic | coronary artery bypass grafting surgery coronary artery disease myocardial infarction outcome percutaneous coronary intervention revascularization |
| url | http://www.heartviews.org/article.asp?issn=1995-705X;year=2023;volume=24;issue=3;spage=141;epage=147;aulast=Hesse |
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