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Published on: March 27, 2018
Coronary artery bypass surgery versus coronary stenting: risk-adjusted survival rates in 5,619 patients
Rollo P Villareal1, Vei-Vei Lee, MacArthur A Elayda
1Department of Cardiology, Texas Heart Institute and St Luke's Episcopal Hospital, Houston 77030, USA.
Insights
Coronary artery bypass surgery (CABG) had higher in-hospital mortality than stenting. However, long-term survival rates were similar for both procedures in patients with multivessel disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Outcomes Research
Background:
- Coronary artery bypass surgery (CABG) and coronary stenting are primary revascularization methods for multivessel coronary artery disease.
- Choosing between CABG and stenting involves considering procedural risks, short-term outcomes, and long-term survival.
- Previous studies have yielded mixed results regarding the comparative effectiveness of these revascularization strategies.
Purpose of the Study:
- To compare in-hospital mortality and long-term survival after first-time coronary artery bypass surgery (CABG) versus coronary stenting.
- To identify patient subgroups that may benefit from one revascularization strategy over the other.
- To evaluate the intermediate-term effectiveness of CABG and stenting in patients with multivessel coronary artery disease.
Main Methods:
- Retrospective analysis of 2,826 patients undergoing first CABG and 2,793 patients undergoing first coronary stenting from January 1995 to December 1999.
- Patients were stratified into 8 anatomic groups based on vessel disease extent and left anterior descending coronary artery involvement.
- Proportional hazards methods were used to adjust mortality rates for baseline differences in disease severity and comorbidities.
Main Results:
- In-hospital mortality was significantly higher for CABG (3.6%) compared to stenting (0.75%; adjusted OR 8.4, P < 0.0001).
- At a mean 2.5-year follow-up, risk-adjusted survival rates were similar between CABG (91%) and stenting (95%; adjusted OR 1.26, P = 0.06).
- Stenting showed a survival advantage in patients >65 years, those with non-insulin-requiring diabetes, and those with noncoronary vascular disease.
Conclusions:
- Coronary artery bypass surgery (CABG) is associated with higher periprocedural mortality than percutaneous coronary intervention (stenting).
- The survival advantage of stenting diminishes by 2.5 years post-procedure, with equivalent long-term survival observed between the two methods.
- In patients with multivessel disease amenable to stenting, there appears to be no intermediate-term survival advantage of CABG over stenting.
Abstract:
We used the Texas Heart Institute Cardiovascular Research Database to retrospectively identify patients who had undergone their 1st revascularization procedure with coronary artery bypass surgery (CABG; n=2,826) or coronary stenting (n=2,793) between January 1995 and December 1999. Patients were classified into 8 anatomic groups according to the number of diseased vessels and presence or absence of proximal left anterior descending coronary artery disease. Mortality rates were adjusted with proportional hazards methods to correct for baseline differences in severity of disease and comorbidity. We found that in-hospital mortality was significantly greater in patients undergoing CABG than in those undergoing stenting (3.6% vs 0.75%; adjusted OR 8.4; P < 0.0001). At a mean 2.5-year follow-up, risk-adjusted survival was equivalent (CABG 91%, stenting 95%; adjusted OR 1.26; P = 0.06). When subgroups matched for severity of disease were compared, no differences in risk-adjusted survival were seen. A survival advantage of stenting was noted in 3 categories of patients: those >65 years of age (OR 1.33, P = 0.049), those with non-insulin-requiring diabetes (OR 2.06, P = 0.002), and those with any noncoronary vascular disease (OR 1.59, P = 0.009). In this nonrandomized observational study, CABG had a higher periprocedural mortality rate than did percutaneous stenting. At 2.5 years, however, the survival advantage of stenting was no longer evident. These data suggest that there is no intermediate-term survival advantage of CABG over stenting in patients who have multivessel disease with lesions that can be treated percutaneously.
