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Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease
Mineok Chang1, Jung-Min Ahn1, Cheol Whan Lee1
1Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Insights
Coronary artery bypass graft (CABG) surgery significantly lowers long-term mortality compared to percutaneous coronary intervention (PCI) with drug-eluting stents in patients with multivessel coronary artery disease. CABG also reduces myocardial infarction and repeat revascularization rates.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Diabetic patients with multivessel coronary artery disease (CAD) show better survival with coronary artery bypass graft (CABG) surgery than percutaneous coronary intervention (PCI).
- Limited data exist on mortality differences between CABG and PCI in nondiabetic patients with multivessel CAD.
Purpose of the Study:
- To compare the long-term mortality effects of CABG versus PCI with drug-eluting stents in nondiabetic patients with multivessel CAD.
- To conduct a patient-level meta-analysis using data from the SYNTAX and BEST trials.
Main Methods:
- Patient-level data from SYNTAX and BEST trials were pooled.
- A total of 1,275 nondiabetic patients with multivessel CAD were included.
- The primary outcome was all-cause mortality, with a median follow-up of 61 months.
Main Results:
- Coronary artery bypass graft (CABG) surgery was associated with significantly lower all-cause mortality compared to percutaneous coronary intervention (PCI) (HR: 0.65; 95% CI: 0.43–0.98; p = 0.039).
- CABG also demonstrated lower rates of cardiac death, myocardial infarction (HR: 0.40; 95% CI: 0.24–0.65), and repeat revascularization (HR: 0.55; 95% CI: 0.40–0.75).
- No significant difference in stroke rates was observed between CABG and PCI (HR: 1.13; 95% CI: 0.59–2.17).
Conclusions:
- Coronary artery bypass graft (CABG) surgery significantly reduces long-term mortality in nondiabetic patients with multivessel coronary artery disease.
- The benefits of CABG over PCI with drug-eluting stents were consistent across major subgroups.
- CABG is a superior revascularization strategy for this patient population regarding long-term survival and key adverse events.
Background:
In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients.
Objectives:
This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD.
Methods:
Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause.
Results:
The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001).
Conclusions:
CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.
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