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Coronary artery bypass vs percutaneous coronary intervention in under 50s
Ahmed M A Shafi1, Al-Rehan A A Dhanji1, Ahmed M Habib1
1Department of Cardiothoracic Surgery, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Insights
Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) for young patients with 3-vessel disease, showing fewer major adverse cardiac or cerebrovascular events (MACCE) at 12 years.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Young patients (≤50 years) with coronary artery disease (CAD) often receive percutaneous coronary intervention (PCI) to defer coronary artery bypass grafting (CABG).
- The long-term validity of prioritizing PCI over CABG in this demographic remains under investigation.
Purpose of the Study:
- To compare the clinical outcomes of CABG versus PCI in young patients (≤50 years) with CAD.
- To evaluate the long-term efficacy and safety of revascularization strategies in this patient population.
Main Methods:
- Retrospective study of 100 consecutive patients undergoing PCI and 100 undergoing CABG in 2004.
- Comparison of major adverse cardiac or cerebrovascular event (MACCE) rates at 5 and 12 years follow-up.
Main Results:
- At 5 and 12 years, PCI patients had significantly higher rates of myocardial infarction (MI) and repeat revascularization compared to CABG patients.
- Patients with 3-vessel disease (3VD) undergoing PCI experienced substantially higher rates of MI, repeat revascularization, and MACCE than those undergoing CABG.
- No significant differences in outcomes were observed between PCI and CABG for patients with 1 or 2-vessel disease.
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates superior long-term outcomes compared to percutaneous coronary intervention (PCI) in young patients with coronary artery disease.
- CABG should be the preferred revascularization strategy for young patients diagnosed with 3-vessel disease due to lower rates of MI and repeat revascularization.
Background:
Young patients with coronary artery disease are undergoing percutaneous coronary intervention (PCI) primarily, with a view to deferring coronary artery bypass grafting (CABG). We investigated the validity of this approach, by comparing outcomes in patients ≤50 years undergoing CABG or PCI.
Methods:
One hundred consecutive patients undergoing PCI and 100 undergoing CABG in 2004 were retrospectively studied to allow for 5 and 12 years follow-up. The two groups were compared for the primary endpoints of major adverse cardiac or cerebrovascular event (MACCE).
Results:
Diabetes, peripheral vascular disease, and left ventricular ejection fraction <50% were higher in the CABG group. At 5 years, rates of myocardial infarction (MI) (9% vs 1%, P = .02), repeat revascularization (31% vs 7%, P < .01), and MACCE (34 vs 12, P < .01) were greater in the PCI vs the CABG group. Similarly, at 12 years, rates of MI (27.4% vs 19.4%, P = .19), repeat revascularization (41.1% vs 20.4%, P < .01), and MACCE (51 vs 40, P = .07) were greater in the PCI group. There were no differences in major outcomes in patients with 1 or 2VD, at 5 or 12 years. Rates of MI, revascularization, and MACCE were higher in patients with 3VD undergoing PCI (n = 21; MI, 47.6%; revascularization, 66.7%; and MACCE, 19 events) vs CABG (n = 78; MI, 19.2%; revascularization, 20.5%; and MACCE, 31 events); P < .01, for all end points.
Conclusions:
MACCE was lower in young patients undergoing CABG vs PCI at both 5 and 12 years follow-up, primarily as a consequence of patients with 3VD undergoing PCI having more MI and repeat revascularization. CABG should remain the preferred method of revascularization in young patients with 3VD.
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