Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era.
BACKGROUND
Observational registries comparing coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) have reported long-term survival results that are discordant with those of randomized trials.


RESULTS
We conducted a multicenter study in Japan enrolling consecutive patients undergoing first CABG or PCI between January 2000 and December 2002. Among 9877 patients enrolled, 5420 (PCI: 3712, CABG: 1708) had multivessel disease without left main involvement. Because age is an important determinant when choosing revascularization strategies, survival analysis was stratified by either age >/=75 or <75 years. Analyses were also performed in other relevant subgroups. Median follow-up interval was 1284 days with 95% follow-up rate at 2 years. At 3 years, unadjusted survival rates were 91.7% and 89.6% in the CABG and PCI groups, respectively (log rank P=0.26). After adjustment for baseline characteristics, survival outcome tended to be better after CABG (hazard ratio for death after PCI versus CABG [HR], 95% confidence interval [CI]: 1.23 [0.99-1.53], P=0.06). Adjusted survival outcomes also tended to be better for CABG among elderly patients (HR [95%CI]: 1.37 [0.98-1.92] P=0.07), but not among nonelderly patients (HR [95% CI]: 1.09 [0.82-1.46], P=0.55). Unadjusted and adjusted survival outcome for CABG and PCI were not significantly different in any subgroups when elderly patients were excluded from analysis.


CONCLUSIONS
In the CREDO-Kyoto registry, survival outcomes among patients <75 years of age were similar after PCI and CABG, a result that is consistent with those of randomized trials.
Kimura
Takeshi
T
Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. taketaka@kuhp.kyoto-u.ac.jp
Morimoto
Takeshi
T
Furukawa
Yutaka
Y
Nakagawa
Yoshihisa
Y
Shizuta
Satoshi
S
Ehara
Natsuhiko
N
Taniguchi
Ryoji
R
Doi
Takahiro
T
Nishiyama
Kei
K
Ozasa
Neiko
N
Saito
Naritatsu
N
Hoshino
Kozo
K
Mitsuoka
Hirokazu
H
Abe
Mitsuru
M
Toma
Masanao
M
Tamura
Toshihiro
T
Haruna
Yoshisumi
Y
Imai
Yukiko
Y
Teramukai
Satoshi
S
Fukushima
Masanori
M
Kita
Toru
T
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards; D002648:Child; D001026:Coronary Artery Bypass / Q000401:mortality / Q000592:standards; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008670:Metals; D008875:Middle Aged; D012042:Registries; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D008670:Metals