Compared with PCI using bare-metal stents or drug-eluting stents, multiarterial CABG was associated with improved long-term survival and reintervention-free survival.
Researchers studied longer-term outcomes of CABG vs. PCI in 8,402 patients with multivessel disease who had procedures at Mount Sinai Beth Israel Medical Center in New York from 1994 to 2011. Of those, 2,381 underwent PCI with DES (mean age, 66 years), 2,289 underwent single arterial CABG (mean age, 69 years), 2,207 underwent PCI with BMS (mean age, 66 years) and 1,525 underwent multiarterial CABG (mean age, 58 years).
Patients who underwent PCI with BMS had poorer survival outcomes from the time of procedure until 7 years of follow-up compared with single-artery CABG (P = .015). Through 9 years of follow-up, the survival rate for BMS PCI was 76.3% compared with 86.9% for multiarterial CABG (P < .001).
Patients who underwent PCI with DES had a similar rate of survival as patients who underwent single-artery CABG; however, single-artery CABG was associated with a modest survival benefit over DES PCI during the first 3 years of follow-up (P = .615). Through 9 years of follow-up, the survival rate for DES PCI was 82.8% compared with 89.8% with for multiarterial CABG (P < .001).
The risk for reintervention was increased among all patients who underwent PCI compared with CABG (P < .001).
“The novel finding of the current study is that [multiarterial] CABG is associated with large death-free and reintervention-free survival advantages over BMS and, more pertinently, DES PCI,” the researchers concluded. “This unique and important finding represents a potentially game-changing perspective to the ongoing PCI vs. CABG debate. Specifically, the benefits attributable to [multiarterial] CABG are substantially greater than those previously reported with [single-arterial] CABG. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.