Coronary artery revascularization evaluation--a multicenter registry with seven years of follow-up

Data from randomized clinical trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, in which there is off-label usage of drug-eluting stents (DES). We undertook a prospective registry of coronary revascularization by CABG on- and off-pump and PCI with bare-metal stents (BMSs), DESs, or percutaneous transluminal coronary angioplasty (PTCA) to determine clinical outcomes.

All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Final follow-up was obtained after 5 years by patient and/or physician contact and the Social Security Death Index. ST-elevation myocardial infarction and salvage patients were excluded. Five or more years of follow-up was obtained on 81.5% (3156) of the eligible patients-968 CABG patients (82.0%) and 2188 PCI patients (81.3%). Overall follow-up was 63.5±27.9 months (median, 79.7 months). The incidence of initial major adverse cardiac events (MACEs) at follow-up for CABG versus PCI was 29.2% versus 41.8% (P<0.001). Analysis of stent subgroups showed more events with BMSs (equivalent to PTCA alone) compared with DESs. All stents had more events than on- or off-pump CABG groups. Using propensity score-matched groups, the odds ratio for CABG to PCI was 0.69 (95% confidence interval [CI], 0.56 to 0.85; P<0.001) for mortality and 0.58 (95% CI, 0.45 to 0.75; P<0.001) for any MACE.

In the current era of DES and off-pump surgery, in a community hospital setting, comparable patients undergoing coronary revascularization appear to benefit from improved long-term survival and reduced MACE with CABG versus PCI.