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Updated: Jul 25, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Contemporary Coronary Artery Bypass Grafting vs Multivessel Percutaneous Coronary Intervention
J Hunter Mehaffey1, J W Awori Hayanga1, Mohammad Kawsara2
1Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
Insights
Coronary artery bypass grafting (CABG) showed better outcomes than percutaneous coronary intervention (PCI) for multivessel disease in Medicare patients. CABG led to lower mortality, fewer readmissions, and improved survival over three years.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Outcomes
Background:
- Recent guideline changes for coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease warrant reevaluation.
- Contemporary outcomes comparing CABG and multivessel PCI require investigation using real-world data.
Purpose of the Study:
- To compare the contemporary outcomes of coronary artery bypass grafting (CABG) versus multivessel percutaneous coronary intervention (PCI) in Medicare beneficiaries with multivessel disease.
Main Methods:
- Analysis of the US Centers for Medicare and Medicaid Services database (2018-2020) for acute coronary syndrome patients undergoing isolated CABG or multivessel PCI.
- Risk adjustment using multilevel regression, Cox proportional hazards models, and inverse probability of treatment weighting (IPTW) propensity scores.
Main Results:
- A total of 104,127 patients were analyzed (CABG: 51,389; PCI: 52,738).
- After IPTW adjustment, CABG was associated with significantly lower hospital mortality (OR, 0.74), fewer 3-year hospital readmissions (OR, 0.85), fewer coronary reinterventions (HR, 0.37), and improved 3-year survival (HR, 0.51) compared to PCI.
Conclusions:
- Contemporary real-world data from Medicare patients indicate superior outcomes for CABG compared to PCI in treating multivessel disease.
- Findings provide crucial longitudinal data to inform patient care decisions and policy development in cardiovascular interventions.
Background:
Interpretation of recent alterations to the guideline priority of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease contests historical data and practice. To reevaluate contemporary outcomes, a large contemporary analysis was conducted comparing CABG with multivessel PCI among Medicare beneficiaries.
Methods:
The United States Centers for Medicare and Medicaid Services database was evaluated all beneficiaries with acute coronary syndrome undergoing isolated CABG or multivessel PCI (2018-2020). Risk adjustment was performed using multilevel regression analysis, Cox proportional hazards time to event models, and inverse probability of treatment weighting propensity scores.
Results:
A total of 104,127 beneficiaries were identified undergoing CABG (n = 51,389) or multivessel PCI (n = 52,738). Before risk adjustment, compared with PCI, CABG patients were associated with younger age (72.9 vs 75.2 years, P < .001), higher Elixhauser Comorbidity Index (5.0 vs 4.2, P < .001), more diabetes (48.5% vs 42.2%, P < .001), higher cost ($54,154 vs $33,484, P < .001), and longer length of stay (11.9 vs 5.8 days, P < .001). After inverse probability of treatment weighting propensity score adjustment, compared with PCI, CABG was associated with lower hospital mortality (odds ratio, 0.74; P < .001), fewer hospital readmissions at 3 years (odds ratio, 0.85; P < .001), fewer coronary reinterventions (hazard ratio, 0.37; P < .001), and improved 3-year survival (hazard ratio, 0.51; P < .001).
Conclusions:
Contemporary real-world data from Medicare patients with multivessel disease reveal that CABG outcomes were superior to PCI, providing important longitudinal data to guide patient care and policy development.
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