Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Observational studies on coronary artery bypass graft (CABG) surgery versus percutaneous coronary intervention (PCI) have yielded long-term survival data inconsistent with randomized trials.
• Discrepancies highlight the need for further investigation into revascularization strategies.

Purpose of the Study:

• To compare long-term survival outcomes between CABG and PCI in patients with multivessel disease without left main coronary artery involvement.
• To analyze survival data stratified by age, specifically comparing elderly (>/=75 years) and non-elderly (<75 years) patient groups.

Main Methods:

• A multicenter observational study in Japan enrolled 9,877 consecutive patients undergoing their first CABG or PCI between January 2000 and December 2002.
• Survival analysis was performed using Cox proportional hazards models, stratified by age (>/=75 vs. <75 years) and other relevant subgroups.
• Median follow-up was 1284 days, with a 95% follow-up rate at 2 years.

Main Results:

• At 3 years, unadjusted survival rates were 91.7% for CABG and 89.6% for PCI (P=0.26).
• After adjustment for baseline characteristics, survival tended to favor CABG (Hazard Ratio [HR] for PCI vs. CABG: 1.23, P=0.06).
• Adjusted survival favored CABG in elderly patients (HR: 1.37, P=0.07) but not in non-elderly patients (HR: 1.09, P=0.55). No significant differences were found when elderly patients were excluded.

Conclusions:

• In the CREDO-Kyoto registry, PCI and CABG demonstrated similar survival outcomes for patients under 75 years of age.
• This finding aligns with results from randomized clinical trials, suggesting comparable efficacy in this patient group.