Survival probability loss from percutaneous coronary intervention compared with coronary artery bypass grafting
Umberto Benedetto1, Mohamed Amrani1, Toufan Bahrami1
1Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
Insights
Coronary artery bypass grafting (CABG) significantly reduces late-phase mortality compared to percutaneous coronary intervention (PCI) in patients with multivessel disease, regardless of age. This survival benefit of CABG over PCI is consistent across all age demographics.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- The comparative survival benefits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for multivessel coronary artery disease (CAD) in older populations remain incompletely understood.
- Investigating the age-specific impact of PCI versus CABG on patient survival is crucial for optimizing treatment strategies.
Purpose of the Study:
- To determine if the survival advantage of CABG over PCI in multivessel CAD is influenced by patient age.
- To analyze the relationship between patient age and the long-term survival outcomes following PCI compared to CABG.
Main Methods:
- A propensity score-matched analysis included 6723 patients with multivessel CAD (1097 PCI, 5626 CABG).
- Drug-eluting stents were predominantly used in the PCI group (83.5%).
- Hazard ratios and confidence intervals were calculated for early (≤12 months) and late (>12 months) post-procedural phases across various age strata.
Main Results:
- Over a mean follow-up of 5.5 years, CABG demonstrated superior survival rates compared to PCI (8-year survival: 90% vs. 75%, P < .001).
- PCI offered no significant early survival benefit over CABG.
- A significant survival disadvantage associated with PCI versus CABG was observed during the late hazard phase across all age groups, with hazard ratios consistently above 1.
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with a significant reduction in late-phase mortality compared to percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease.
- This survival benefit of CABG over PCI is evident and consistent across all age groups studied.
Background:
Whether the survival benefit from coronary artery bypass grafting (CABG), compared with percutaneous coronary intervention (PCI), for multivessel disease extends to the older segment of the population remains unclear. We aimed to investigate whether the effect on survival of PCI compared with CABG is related to the age of the patient.
Methods:
Propensity score-matching analysis was conducted on 6723 patients (PCI = 1097, CABG = 5626) with multivessel coronary artery disease. In the PCI group, drug-eluting stents were used in 917 (83.5%) patients; bare metal stents were used in only 180 patients (16.5%). Nonparametric, bootstrap, point-wise confidence limits were obtained for PCI:CABG odds and hazard ratios for early (within 12 months) and late hazard phase (beyond 12 months) for a variety of age groups.
Results:
After a mean follow-up time of 5.5 ± 3.2 years, a total of 301 deaths were recorded in the matched sample (208 in the PCI group and 93 in the CABG group). Overall survival was 95% ± 0.6% versus 95% ± 0.6% at 1 year, 84% ± 1.0% versus 92.4% ± 0.8% at 5 years, and 75% ± 1.6% versus 90% ± 1.0% at 8 years, for the PCI and CABG groups, respectively (log rank P < .001). PCI did not confer any significant benefit compared with CABG during the early hazard phase (within 12 months), but the survival-probability loss from PCI compared with CABG during the late hazard phase was present across all age groups. The hazard ratio declined from 3.8 to 3.4 and was statistically significant (lower limit >1 across all ages, ranging from 1.5 to 2.4).
Conclusions:
Compared with PCI, CABG leads to a significant reduction in late-phase mortality across all age groups.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care