Composite outcomes in coronary bypass surgery versus percutaneous intervention

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Outcomes Research

Background:

• Observational studies suggest long-term survival benefits of Coronary Artery Bypass Grafting (CABG) over Percutaneous Coronary Intervention (PCI) for multivessel coronary disease.
• Nonfatal outcomes are critical considerations for treatment recommendations in these patients.

Purpose of the Study:

• To compare the long-term effectiveness of CABG versus PCI in patients with stable multivessel coronary disease.
• To evaluate a composite of death, myocardial infarction (MI), or stroke as a primary endpoint.

Main Methods:

• A comparative analysis of Medicare patients undergoing CABG or PCI for stable multivessel coronary disease (2004-2008).
• Utilized national registry data linked with Medicare data for up to 4 years of follow-up.
• Employed propensity scoring with inverse probability weighting to adjust for baseline differences.

Main Results:

• The study included 86,244 CABG patients and 103,549 PCI patients, with a mean age of 74 and median follow-up of 2.67 years.
• At 4 years, CABG showed a significantly lower incidence of MI (3.2% vs. 6.6%) and a composite of death, MI, or stroke (21.6% vs. 26.7%).
• PCI demonstrated a lower incidence of stroke at 4 years (3.1% vs. 4.5%), largely due to a higher 30-day stroke rate with CABG (1.55% vs. 0.37%).

Conclusions:

• Coronary Artery Bypass Grafting (CABG) was associated with a more favorable 4-year composite outcome of death, myocardial infarction, or stroke compared to Percutaneous Coronary Intervention (PCI).
• Percutaneous Coronary Intervention (PCI) offered a reduced risk of stroke as a standalone event.