Ten year outcomes in three vessel disease treated by CABG versus PCI in an Eastern European registry

Long-term outcomes in ischemic heart disease are historically underreported in Eastern Europe. Our aim was to report 10-year survival and to identify outcome predictors in patients with three-vessel coronary artery disease (CAD) treated by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) in an Eastern European center. Patients treated for three-vessel CAD with CABG or PCI with drug-eluting stents between August 2013 and February 2025 in a Romanian tertiary hospital were selected for inclusion in this study. All-cause and cardiovascular-cause survival data were available as of May 2025. A total of 7014 patients were included, of which 2759 (39.3%) were treated with CABG and 4255 (60.6%) were treated with PCI. The 10-year all-cause and cardiovascular-cause survival rates were 50.5% and 57.7%, respectively. The CABG group had both higher all-cause and cardiovascular cause mortality than the PCI group (log-rank p = 0.01 and p = 0.03, respectively). CABG was an independent protective predictor, with patients having at least one arterial graft performing better survival than patients having venous grafts only. PCI was an independent predictor of events, with patients undergoing single coronary stenting having better survival than patients undergoing multiple coronary stenting. The 10-year survival after CABG or PCI is lower in Eastern Europe than that reported by other Western registries. However, at the 10-year follow-up, CABG associated with lower incidence of all-cause and cardiovascular-cause death when compared to PCI. These results provide contemporary evidence regarding the long-term benefit of CABG in patients with complex CAD in a real-world scenario.