Percutaneous versus surgical revascularization for multivessel coronary artery disease: a single center 10 year follow-up of SOS trial patients.
OBJECTIVE
To compare 10 year outcomes including death, left ventricular ejection fraction (LVEF), major adverse cardiovascular and cerebrovascular events (MACCE), repeat revascularization (RR), and severity of angina (CCS) after randomization to stent supported percutaneous coronary intervention (PCI) or surgical revascularization (CABG) in a single center participating in the SOS trial.


BACKGROUND
Randomized studies show increased RR following PCI, but otherwise similar results to CABG in selected mutlivessel disease patients with up to 5 year follow up. There is no 10 year data available.


METHODS
The analysis involved 100 patients randomized into the SOS study in Poland.


RESULTS
Patients were well matched for baseline demographic and angiographic characteristics. During 9.6 +/- 0.85 year observation, there was no significant difference between groups for survival, CCS, and LVEF. Increased RR occurred following PCI; 21 (42%) vs. 9 (18%), P < 0.05. As a consequence, the MACCE was also significantly higher following PCI; 36 (72%) vs. 28 (56%), P < 0.05. Excess RR predominantly occurred in the first year and diminished over time with numerically less RR following PCI from year 5 to 10; 2 (4%) vs. 7 (14%), P = ns.


CONCLUSIONS
These findings suggest that patients with multivessel coronary artery disease technically suitable for either stent supported PCI or CABG have very similar 10 year outcomes with respect to mortality, angina class, LVEF, and MACCE other than RR. Excess RR following PCI predominantly occurs in early years and is numerically lower following PCI in years 5-10. This underscores the need for longer-term follow up from randomized trials.
Upper Silesian Medical Center, 45-47 Ziolowa, 40-635 Katowice, Poland. pbuszman@ka.onet.pl
Pawel
P
Buszman
Szymon
S
Wiernek
Radoslaw
R
Szymanski
Bozena
B
Bialkowska
Piotr
P
Buszman
Wojciech
W
Fil
Rodney
R
Stables
Andrzej
A
Bochenek
Jack
J
Martin
Michal
M
Tendera
D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011044:Poland / Q000453:epidemiology; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left