[Comparison of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left...

To compare the short- and long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left ventricular dilatation (LVD).

From July 2003 to September 2005, we enrolled 251 patients with severe LVD to undergo coronary revascularization with either PCI (n = 101) or CABG (n = 150) and analyzed the effects of different revascularization strategies on the in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE).

Compared with those in the CABG group, the patients in the PCI group had lower incidence of in-hospital MACCE events [3.0% (3/101) vs 10.7% (16/150), P = 0.024], due mainly to a lower in-hospital mortality (2.0%vs 8.7%, P = 0.028). Ninety-nine (98.0%) patients in the PCI group and 136 (90.7%) patients in the CABG group were followed up for (516 ± 182) days and (515 ± 231) days, respectively. Although no difference existed in the follow-up incidence of MACCE between two groups, the PCI patients had a trend of a higher incidence of MACCE events [18.2% (18/99) vs 9.6% (13/136), P = 0.054], due mainly to a higher rate of repeat revascularization [14 (14.1%) vs (0.7%), P < 0.01]. Two patients groups had the comparable follow-up rates of mortality [4 (4.0%) vs 12 (8.8%), P = 0.151], myocardial infarction [2 (2.0%) vs 1 (0.7%), P = 0.781] and stroke [2 (2.0%) vs 0 (0.0%), P = 0.176].

For the patients with severe LVD. PCI is both safe and feasible. And it has a lower rate of in-hospital mortality, and a comparable incidence of follow-up MACCE events. However, the rate of follow-up repeat revascularization is higher.