PCI or CABG for left main coronary artery disease: the SWEDEHEART registry
Jonas Persson1, Jacinth Yan2, Oskar Angerås3
1Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Entrevägen 2, 182 88 Stockholm, Sweden.
European Heart Journal
|June 8, 2023
Summary
Coronary artery bypass grafting (CABG) is linked to better survival rates than percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease. CABG also resulted in fewer major adverse cardiovascular events, especially for diabetic patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Unprotected left main coronary artery (LMCA) disease poses significant risks.
- Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary treatment options.
- Comparative outcome data for LMCA disease are crucial for clinical decision-making.
Purpose of the Study:
- To compare the long-term outcomes of CABG versus PCI in patients with unprotected LMCA disease.
- To analyze differences in mortality, myocardial infarction, stroke, and revascularization rates.
- To investigate the impact of diabetes on treatment outcomes.
Main Methods:
- Observational, nationwide, all-comers prospective register study.
- Utilized the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry (2005-2015).
- Employed Cox regression with inverse probability weighting (IPW) and instrumental variable (IV) analysis to adjust for confounders.
Main Results:
- CABG was associated with significantly lower mortality and major adverse cardiovascular and cerebrovascular events (MACCE) compared to PCI.
- IPW analysis showed a higher hazard ratio (HR) for mortality with PCI (HR 2.0, 95% CI 1.5-2.7).
- IV analysis revealed a longer median survival time favoring CABG in diabetic patients (3.6 years longer).
Conclusions:
- CABG demonstrates superior outcomes regarding mortality and MACCE compared to PCI in unprotected LMCA disease.
- The benefits of CABG are particularly pronounced in diabetic patients.
- These findings support CABG as a preferred revascularization strategy for unprotected LMCA disease.
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