Current clinical outcomes of percutaneous coronary intervention and coronary artery bypass grafting.
BACKGROUND
Randomized trials have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). However, results of these trials in select patients may not accurately reflect current clinical practice using drug-eluting stents (DES) and off-pump CABG. We undertook a prospective registry of coronary revascularization by CABG on-pump and off-pump, and PCI with or without DES, to determine clinical outcomes.


METHODS
All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Preprocedural, intraprocedural, and postprocedural data were captured, with outcomes obtained at 18 months by patient and physician contact, and the Social Security Death Index.


RESULTS
The study enrolled 4336 patients, 71.2% PCI and 28.8% CABG. DESs were used in 2249 PCIs (73.1%), and 596 CABG procedures (47.8%) were off-pump. Incidence of major adverse cardiac events at 18 months was 14.7% for CABG vs 23.3% for PCI (p < 0.001). Cardiac death and myocardial infarction had similar rates. The need for repeat revascularization was significantly less with CABG (6.2% vs 13.6%, p < 0.001). Hazard ratio of CABG to PCI was 0.76 (95% confidence interval, 0.571 to 0.872). CABG outcome was similar on-pump and off-pump, as was repeat revascularization with DES (12.1%) vs BMS (14.9%; p = 0.096). Overall event-free survival was 85.3% in CABG and 76.8% in PCI (p < 0.001).


CONCLUSIONS
Rates of repeat revascularization were significantly higher for PCI than for CABG, but mortality and myocardial infarction were the same. There were no significant differences in outcomes between DES and BMS or between on-pump and off-pump CABG.
Mack
Michael J
MJ
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. slhill@csant.com
Prince
Syma L
SL
Herbert
Morley
M
Brown
Phillip P
PP
Katz
Marc
M
Palmer
George
G
Edgerton
James R
JR
Eichhorn
Eric
E
Magee
Mitchell J
MJ
Dewey
Todd M
TM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000628:therapy; D003925:Diabetic Angiopathies / Q000601:surgery / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D019233:Retreatment; D015607:Stents; D016019:Survival Analysis