Long-term mortality of coronary artery bypass grafting and bare-metal stenting

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Limited data exists on long-term survival (over 5 years) for coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with stenting.
• Multivessel coronary disease poses significant long-term health challenges for patients.

Purpose of the Study:

• To compare the 8-year mortality risk between CABG and bare-metal stent PCI in patients with multivessel coronary disease.
• To test the hypothesis that CABG offers superior long-term survival compared to stenting for this patient group.

Main Methods:

• A cohort study identified 18,359 CABG patients and 13,377 bare-metal stent PCI patients from New York (1999-2000).
• Vital status was tracked through 2007 using the National Death Index.
• Patients were matched based on disease extent, proximal left anterior descending (LAD) artery involvement, and propensity for CABG.

Main Results:

• Matched analysis of 7,235 pairs revealed 8-year survival rates of 78.0% for CABG versus 71.2% for stenting (HR 0.68, p < 0.001).
• Lower mortality risk with CABG was consistent across subgroups, including those with 2- or 3-vessel disease and proximal LAD involvement.
• Hazard ratios for death ranged from 0.53 (3-vessel disease with LAD involvement) to 0.78 (2-vessel disease without LAD involvement).

Conclusions:

• Coronary artery bypass grafting is associated with a significantly lower risk of long-term mortality compared to bare-metal stent PCI for multivessel coronary disease.
• These findings support CABG as a preferred revascularization strategy for select patients with complex coronary artery disease.
• Long-term survival benefits of CABG extend across various patient subgroups and disease complexities.