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Published on: May 14, 2013
Revascularization following non-ST elevation myocardial infarction in multivessel coronary disease
Lauren V Huckaby1, Ibrahim Sultan1, Suresh Mulukutla2
1Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Coronary artery bypass grafting (CABG) significantly improves survival and reduces adverse events compared to percutaneous coronary intervention (PCI) for multivessel coronary artery disease (MVCAD) with non-ST elevation myocardial infarction (NSTEMI). This benefit persists even with complete revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The optimal revascularization strategy for multivessel coronary artery disease (MVCAD) remains a subject of debate.
- Non-ST elevation myocardial infarction (NSTEMI) in patients with MVCAD requires careful consideration of treatment approaches.
Purpose of the Study:
- To compare the long-term outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with MVCAD presenting with NSTEMI.
- To evaluate the impact of revascularization strategy on mortality, major adverse cardiac and cerebrovascular events (MACCE), and readmissions.
Main Methods:
- A retrospective analysis of adult patients with MVCAD and NSTEMI treated with either CABG or PCI between 2011 and 2018.
- Multivariable analysis was employed to identify independent predictors of adverse outcomes.
- A subanalysis focused on patients who achieved complete revascularization.
Main Results:
- Coronary artery bypass grafting (CABG) was performed in 74.0% of the 2001 included patients.
- CABG was associated with significantly lower risk-adjusted mortality (HR 0.59, P < .001) and improved 1- and 5-year survival rates (80.7% vs 63.3% at 5 years).
- Patients undergoing CABG experienced greater freedom from MACCE, lower rates of myocardial infarction (MI), and reduced need for repeat revascularization compared to PCI (all P < .001).
Conclusions:
- In real-world practice, CABG demonstrates superior outcomes compared to PCI for patients with MVCAD and NSTEMI.
- Coronary artery bypass grafting (CABG) leads to improved survival and fewer MACCE and readmissions.
- The benefits of CABG over PCI in this patient cohort are maintained even when complete revascularization is achieved.
Background:
The optimal revascularization approach for patients with multivessel coronary artery disease (MVCAD) is controversial. We sought to investigate outcomes in patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction (NSTEMI).
Methods:
Adult patients with MVCAD and NSTEMI undergoing either CABG or PCI at a single institution between 2011 and 2018 were included. Multivariable analysis was utilized to determine independent predictors of death, major adverse cardiac and cerebrovascular events (MACCE), and readmissions. A subanalysis examined patients undergoing complete revascularization.
Results:
A total of 2001 patients were included, of whom 1480 (74.0%) underwent CABG. CABG was associated with a lower risk-adjusted hazard for death (hazard ratio, 0.59, P < .001) and with improved survival at 1 year (92.0 vs 81.8%, P < .001) and 5 years (80.7 vs 63.3%, P < .001). Additionally, freedom from MACCE (P < .001) was greater in the CABG group and cumulative readmission, rates of MI, and rates of repeat revascularization were lower with CABG (each P < .001). Among patients undergoing complete revascularization, overall survival (1 year: 92.7 vs 83.9%, P = .010; 5 years: 81.1 vs 69.4%, P < .001) and freedom from MACCE (1 year: 92.3 vs 75.2%, P < .001; 5 years: 81.7 vs 61.4%, P < .001) remained higher for the CABG group; cumulative incidence of readmission was also decreased in those undergoing CABG (P < .001).
Conclusions:
In this real-world analysis of patients with MVCAD presenting with NSTEMI, revascularization with CABG resulted in improved survival with lower rates of MACCE and readmission as compared to PCI, which persisted when accounting for complete revascularization.
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