Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Economics

Background:

• Arterial Revascularization Therapy Study indicated higher repeat revascularization rates post-PCI.
• PCI was less expensive than CABG, with comparable protection against major adverse cardiovascular events.

Purpose of the Study:

• To compare the long-term efficacy and cost-effectiveness of PCI versus CABG in patients with multivessel disease.

Main Methods:

• 1205 patients with multivessel disease were randomized to CABG or PCI.
• Follow-up extended up to 3 years, assessing survival, stroke, myocardial infarction, and repeat revascularization rates.
• Cost-effectiveness analysis was performed.

Main Results:

• Similar survival rates without stroke or myocardial infarction at 1 and 3 years between PCI and CABG groups (approx. 90-91% at 1 year, 87-88% at 3 years).
• Significantly higher repeat revascularization rates in the PCI group (21.2% at 1 year, 26.7% at 3 years) compared to CABG (3.8% at 1 year, 6.6% at 3 years).
• Diabetes and stent deployment pressure predicted events post-PCI; LAD grafting predicted event-free survival post-CABG. Incremental cost per event-free patient was lower at 3 years for PCI.

Conclusions:

• Three-year survival rates for stroke and myocardial infarction are equivalent between PCI and CABG.
• The cost-benefit ratio of PCI is primarily influenced by the increased need for repeat revascularization.