Publication Date
8-14-2015
Keywords
high risk, three-vessel disease, left main, Heart Team, stenting, coronary artery bypass grafting
Abstract
Purpose
Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD.
Methods
Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality >5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study.
Results
Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P<0.001) and had shorter hospital stays (5.6 ± 5.7 days vs. 15.1 ± 10.6 days, P<0.001).
Conclusions
The composite rate of death, myocardial infarction or stroke is similar for PCI and CABG in patients with symptomatic LM-3VD who have STS-predicted operative mortality >5%.
Recommended Citation
Nfor T, Shetabi K, Hassan W, Nfor Q, Khitha J, Gupta A, Bajwa T, Allaqaband S. Clinical outcomes after drug-eluting stents versus coronary artery bypass surgery in high surgical risk patients with left main or three-vessel coronary artery disease. J Patient-Centered Res Rev. 2015;2:95-103. doi: 10.17294/2330-0698.1045
Included in
Cardiology Commons, Cardiovascular Diseases Commons, Other Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Surgical Procedures, Operative Commons
Submitted
January 7th, 2015
Accepted
February 2nd, 2015
