CABG confers mortality benefit over PCI in multivessel CAD
There was a significant mortality benefit in patients with multivessel CAD who underwent CABG compared with those who underwent PCI, according to a study published in The Annals of Thoracic Surgery.
“CABG should be considered in broader patient populations, not just in cases of patients with diabetes and left ventricular dysfunction, which is what is commonly practiced,” Suresh R. Mulukutla, MD, interventional cardiologist and director of cardiac catheterization laboratory research at University of Pittsburgh Medical Center, said in a press release.
Researchers analyzed data from 1,688 patients in a propensity-matched cohort with multivessel CAD who underwent CABG (n = 844; mean age, 67 years; 69% men) or PCI (n = 844; mean age, 68 years; 71% men) between 2010 and 2018.
The primary outcome of interest was mortality. Secondary outcomes of interest included freedom from repeat vascularization and freedom from inpatient readmission.
The estimated mortality rate at 1 year was 11.5% in the PCI group vs. 7.2% in the CABG group (P < .001). Compared with patients who underwent CABG, the HR for mortality in patients who underwent PCI was 1.64 (95% CI, 1.29-2.1).
The HR was 1.42 for readmission in patients who underwent PCI vs. CABG (95% CI, 1.23-1.64). Compared with the CABG group, the PCI group had an HR of 4.06 for repeat revascularization (95% CI, 2.39-6.91).
CABG was favored for overall MACE compared with PCI. In addition, CABG was also favored over PCI for readmission, mortality and repeat revascularization in subgroup analyses.
“We and others have demonstrated the practical feasibility of a coronary revascularization heart team, and given how significantly the revascularization strategy may affect outcomes, use of the heart team should be considered in all patients with [multivessel] CAD according to guidelines,” Mulukutla and colleagues wrote. “Future studies are needed to formally assess the magnitude of benefit of a heart team approach in revascularization.” – by Darlene Dobkowski
Disclosure s : The authors report no relevant financial disclosures.