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Comparison of risk profile and outcomes in patients undergoing surgical and catheter-based revascularization
G S Aldea1, J A Gaudiani, O M Shapira
1The Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston University Medical Center, Massachusetts 02117-2393, USA.
Insights
Coronary artery bypass graft (CABG) surgery and percutaneous transluminal catheter-based revascularization (PTCR) showed comparable clinical outcomes, morbidity, and mortality. This study highlights the need for ongoing reevaluation of revascularization indications and outcomes with evolving techniques.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The impact of recent revascularization trials and advancements in surgical and percutaneous techniques on patient selection and outcomes for coronary artery disease remains unclear.
- This study addresses the evolving landscape of revascularization strategies.
Purpose of the Study:
- To compare clinical outcomes, morbidity, and mortality between coronary artery bypass graft (CABG) surgery and percutaneous transluminal catheter-based revascularization (PTCR).
- To evaluate patient selection criteria and outcomes in the context of contemporary revascularization techniques.
Main Methods:
- A concurrent, contemporary cohort of 982 patients undergoing CABG and 939 patients undergoing PTCR was evaluated at a single institution.
- Patient characteristics, including age, comorbidities (hypertension, diabetes, smoking), prior events (MI, CVA/TIA), and ejection fraction, were compared between groups.
- Angiographic findings and revascularization extent were also assessed.
Main Results:
- Patients undergoing CABG had higher clinical and angiographic risk profiles compared to those undergoing PTCR.
- Despite these differences, outcomes were comparable, with similar rates of death, renal insufficiency, and CVA/TIA between CABG and PTCR.
- CABG patients experienced more pulmonary complications but fewer periprocedural MIs and major complications, alongside longer hospital stays.
Conclusions:
- Coronary artery bypass graft (CABG) surgery and percutaneous transluminal catheter-based revascularization (PTCR) demonstrate comparable clinical results, morbidity, and mortality, even with differing patient risk profiles.
- The study underscores the necessity for continuous reevaluation of indications and outcomes for both revascularization strategies as techniques advance.
Background:
The effects of the randomized revascularization trials and improved strategies and techniques for coronary artery bypass graft (CABG) surgery and percutaneous transluminal catheter-based revascularization (PTCR) on current patient selection and clinical outcomes are unknown.
Methods:
We evaluated a concurrent, contemporary (1995 to 1997), and consecutive group of patients undergoing CABG (n = 982) or PTCR (n = 939) in a single institution that participated in the Bypass Angioplasty Revascularization Investigation (BARI) trial. Results are presented as percent or mean +/- SD. Compared to PTCR, patients undergoing CABG were older (66.2+/-10.7 vs. 62.0+/-11.8 years, p<0.05) with a higher incidence of hypertension (73.3% vs. 52.4%, p<0.05), diabetes (32.5% vs. 23.1%, p<0.05), active smoking (67.8% vs. 27.2%, p<0.05), prior myocardial infarction (MI)(66.8% vs. 28.5%, p<0.05), peripheral vascular disease (19.8% vs. 7.7%, p<0.05), prior cerebrovascular accident (CVA)/transient ischemic attack (TIA) (6.4% vs. 2.8%, p<0.05), and a lower ejection fraction (48.7%+/-14.5% vs. 55.3%+/-11.7%, p<0.05). The presenting functional class and incidence of female gender were similar for both revascularization strategies.
Results:
Compared to patients undergoing CABG, those undergoing PTCR were more likely to have single or two vessel coronary artery disease (88.6% vs. 23.1%, p<0.001) and had fewer vessels revascularized per patient (1.08+/-0.30 vs. 3.5+/-0.98, p<0.001). Outcomes were comparable for CABG and PTCR with a similar incidence of death (1.0% vs. 0.9%, NS), renal insufficiency (0.7% vs. 0.6%, NS), and CVA/TIA (0.9% vs. 0.3%, NS). Patients undergoing CABG had a higher incidence of pulmonary complications (5.2% vs. 1.0%, p<0.05), a lower incidence of periprocedural MI (1.1% vs. 4.1%, p<0.05) and major complication (5.9% vs. 9.4%, p<0.05), but longer hospital stays (6.5+/-5.1 vs. 3.1+/-2.6 days, p<0.05).
Conclusions:
Despite higher clinical and angiographic risk profiles in patients undergoing CABG, clinical results, morbidity, and mortality were comparable to those of PTCR. With evolving techniques, continued reevaluation of indications and outcomes are necessary.