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Updated: Jun 20, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease
Sean Hardiman1, Guy Fradet2, Lisa Kuramoto3
1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Delayed coronary artery bypass grafting (CABG) in stable ischemic heart disease patients resulted in fewer repeat revascularizations compared to timely percutaneous coronary intervention (PCI). Waiting for CABG offers a benefit of reduced repeat procedures over PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Stable ischemic heart disease management often involves revascularization.
- The optimal timing for revascularization procedures, specifically coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI), remains a key clinical question.
- Evidence regarding the impact of delayed CABG on the need for subsequent procedures is limited.
Purpose of the Study:
- To investigate whether the timing of revascularization treatment affects the requirement for repeat procedures in patients with stable ischemic heart disease.
- To compare repeat revascularization rates between patients who underwent delayed CABG versus those who received timely PCI.
Main Methods:
- A cohort of 25,520 British Columbia residents aged 60+ undergoing first-time revascularization for stable left main or multivessel ischemic heart disease (2001-2016) was identified.
- Cumulative incidence functions for repeat revascularization were estimated, accounting for death as a competing risk.
- Statistical adjustments using inverse probability of treatment weights were applied to compare delayed CABG with timely PCI.
Main Results:
- At 3 years, delayed CABG was associated with a significantly lower cumulative incidence of repeat revascularization (4.84%) compared to timely PCI (12.32%).
- The adjusted subdistribution hazard ratio for repeat revascularization was 0.16 (95% CI, 0.04-0.65) for delayed CABG versus timely PCI.
- These findings indicate a substantial reduction in repeat procedures with delayed CABG.
Conclusions:
- Delayed coronary artery bypass grafting is associated with a lower cumulative incidence of repeat revascularization compared to timely percutaneous coronary intervention.
- Patients opting for CABG may experience a benefit of reduced repeat revascularization, even with a delay in treatment.
- This suggests that strategic timing of CABG can impact long-term procedural needs in stable ischemic heart disease.
Objectives:
In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.
Methods:
We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.
Results:
After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).
Conclusions:
Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.
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