CABG was associated with lower rates of MACCE than either PCI or medical therapy in a cohort of patients with multiple chronic total occlusions, according to recent findings.
The researchers compared outcomes among 393 patients with at least two CTOs who were categorized for intention-to-treat analysis using propensity-score matching. The study included 169 patients referred for CABG, 130 for PCI and 94 patients for medical therapy alone. MACCE was the primary endpoint, with secondary endpoints including all-cause and CV-related mortality, cerebrovascular accident, MI and repeat revascularization. The median follow-up was 46.5 months (interquartile range, 22.7-74.6 months).
CABG was associated with a lower MACCE rate than either PCI (HR = 0.43; 95% CI, 0.21-0.85) or medical therapy (HR = 0.1; 95% CI, 0.04-0.27). The rate of repeat revascularization was also lower with CABG compared with PCI (HR = 0.05; 95% CI, 0.01-0.4) or medical therapy (HR = 0.01; 95% CI, 0-0.54).
Cardiac mortality rates were similar between patients who received CABG and those who received PCI (HR = 0.97; 95% CI, 0.37-2.53) but the rate was significantly lower among in the CABG group compared with the medical therapy group (HR = 0.24; 95% CI, 0.08-0.75). Risk for all-cause mortality was also significantly lower in the CABG group compared with the medical therapy group.
The researchers also noted that PCI was associated with lower rates of revascularization (HR = 0.36; 95% CI, 0.14-0.88) and MACCE (HR = 0.46, 95% CI, 0.25-0.84) compared with medical therapy.
“These findings suggest that CABG might be associated with better clinical outcome and considered as the preferred treatment strategy in patients with multiple CTOs,” the researchers concluded. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.