Outcome after coronary artery bypass graft surgery, coronary angioplasty and stenting

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Coronary artery disease (CAD) management involves revascularization strategies like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
• Long-term outcomes comparing these interventions are crucial for clinical decision-making.

Purpose of the Study:

• To investigate the long-term prognosis of patients undergoing balloon angioplasty (PTCA), coronary stenting (CS), and coronary artery bypass grafting (CABG).
• To compare mortality and major adverse cardiac events (MACE) rates among the different revascularization strategies.

Main Methods:

• Prospective observational study including 1038 patients with PTCA (n=499), CS (n=294), or CABG (n=245).
• Follow-up duration of 6.4 ± 1.8 years, analyzing mortality and MACE as primary and secondary endpoints.
• Multivariable analysis identified independent predictors of mortality and MACE.

Main Results:

• Overall mortality rate was 19.3% over the follow-up period.
• Major adverse cardiac events (MACE) occurred in 53.7% of patients.
• Coronary stenting (CS) and CABG demonstrated significantly lower MACE rates compared to PTCA (HR 0.693 and 0.343, respectively).
• Independent predictors of mortality included age, pulse pressure, smoking, diabetes, LDL cholesterol, and left ventricular ejection fraction.
• Further MACE risk factors included high LDL cholesterol, three-vessel CAD, and low ejection fraction (<30%).

Conclusions:

• Long-term mortality rates are comparable across PTCA, CS, and CABG interventions.
• Percutaneous interventions, particularly CS, are associated with a lower risk of MACE compared to traditional PTCA.
• CABG offers the most significant reduction in MACE risk among the studied revascularization strategies.