Coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. Twenty-year clinical outcome

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) requires long-term management strategies.
• Comparing revascularization therapies like CABG and PTCA is crucial for clinical decision-making.
• Long-term outcomes (up to 20 years) of CABG versus PTCA are essential for understanding lifetime disease management.

Purpose of the Study:

• To compare the long-term (20-year) outcomes of coronary artery bypass surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
• To evaluate survival rates and the need for repeat revascularization in patients with multivessel disease treated with CABG or PTCA.
• To provide data for informed clinical decisions regarding revascularization strategies in CAD.

Main Methods:

• A single-center study comparing 1041 consecutive CABG patients (1970-1980) with 702 PTCA patients (1980-1985).
• Mortality and revascularization data were collected up to 20 years post-procedure.
• Survival rates were analyzed using proportional hazards methods to adjust for baseline differences.

Main Results:

• Unadjusted survival rates at 10 years were 77% for CABG and 80% for PTCA.
• In multivessel disease patients, survival was similar, with a CABG benefit in the first 8 years.
• After adjusting for baseline characteristics, the relative risk of mortality was comparable between CABG and PTCA (RR: 1.03).
• Repeat interventions were more frequent after PTCA in the first 8 years, but more frequent after CABG thereafter.

Conclusions:

• Both CABG and PTCA demonstrate equal effectiveness regarding 20-year survival in patients with multivessel disease.
• Long-term differences in outcomes between CABG and PTCA diminish significantly after 10 years.
• The choice between CABG and PTCA involves considering the timing of repeat interventions, which shifts over time.