Coronary Artery Bypass With Multiarterial Grafting vs Percutaneous Coronary Intervention
Valentino Bianco1, Suresh Mulukutla2, Edgar Aranda-Michel3
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Coronary artery bypass grafting (CABG) using multiple arterial grafts significantly improves survival and reduces major adverse events compared to percutaneous coronary intervention (PCI) in patients with multivessel coronary disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Limited data exist comparing multiarterial grafting during CABG versus PCI for multivessel coronary disease.
- This study evaluates the efficacy of multiple arterial conduits in CABG compared to PCI.
Purpose of the Study:
- To compare outcomes between patients undergoing CABG with multiple arterial conduits and those treated with PCI.
- To assess the relevance of arterial grafts in CABG for appropriate patient selection.
Main Methods:
- Retrospective study of patients with coronary artery disease undergoing CABG with multiple arterial conduits or PCI.
- Propensity score matching was used to balance baseline characteristics between groups.
- Kaplan-Meier estimates and Cox regression analysis were performed to evaluate outcomes, including major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- The study included 3648 patients (902 CABG, 2746 PCI), with 838 propensity-matched pairs.
- CABG patients demonstrated significantly lower 30-day mortality (0.8% vs 2.9%) and improved survival over a median follow-up of 4.9 years (87.1% vs 74.6%).
- CABG was associated with greater freedom from MACCE (72.4% vs 40.5%) and a significantly reduced risk of mortality (HR 0.49) and MACCE (HR 0.33).
Conclusions:
- CABG with multiple arterial conduits offers superior outcomes for patients with coronary artery disease.
- This approach leads to significantly fewer major adverse events and reduced hospital readmissions.
- Improved survival rates highlight the benefit of arterial grafting in CABG for selected patients.
Background:
Data comparing patients who undergo multiarterial grafting during coronary artery bypass grafting (CABG) vs percutaneous coronary intervention (PCI) in patients with multivessel coronary disease are scarce. This study addresses the relevance of using multiple arterial conduits vs PCI for appropriate patients.
Methods:
This retrospective study included all patients with coronary artery disease who underwent CABG with multiple arterial conduits or PCI. Propensity score matching was performed for baseline characteristics. Kaplan-Meier estimates, cumulative incidence, and freedom from major adverse cardiac and cerebrovascular events (MACCE) curves were performed.
Results:
The total patient population consisted of 3648 patients from 2011 to 2018 divided into 902 CABG patients and 2746 PCI patients. Patients were propensity matched (PCI, n = 838; CABG, n = 838). In the CABG cohort the left internal mammary artery was used in 837 patients (99.9%), the right internal mammary artery in 770 patients (92%), and radial arteries in 108 patients (12.9%). Patients in the PCI cohort had significantly higher 30-day mortality (24 [2.9%] vs 7 [0.8%], P < .01). Survival over follow-up (median, 4.9 years; range, 3.3-6.8) was better for the CABG cohort (730 [87.1%] vs 625 [74.6%], P < .01). Patients in the CABG cohort had greater freedom from MACCE (607 [72.4%] vs 339 [40.5%], P < .01). Cox multivariable regression showed that patients who underwent CABG had a significantly reduced risk of mortality (hazard ratio, 0.49; 95% confidence interval, 0.39-0.61; P < .01) and of MACCE (hazard ratio, 0.33; 95% confidence interval, 0.28-0.38; P < .01).
Conclusions:
Patients with coronary artery disease who undergo CABG with multiple arterial conduits have significantly fewer major adverse events, improved survival, and reduced hospital readmissions.
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