Comparison of mid-term outcome in patients with three-vessel and/or left main disease undergoing percutaneous coronary intervention and coronary artery bypass graft surgery.
BACKGROUND
To compare the outcome including death, myocardial infarction, stroke, recurrent angina and need for re-intervention in patients with multivessel disease undergoing percutaneous intervention (PCI) or coronary artery bypass graft surgery (CABG). A 'real-world' evaluation of current practice in UK is lacking.


METHODS
A retrospective and ongoing analysis of consecutive patients with three-vessel disease and/or left main stem undergoing PCI or CABG between September 2005 and December 2006 was carried out. In-hospital outcome and outcome measures at 6 and 12 months, including death, myocardial infarction, cerebrovascular events, recurrent angina and re-intervention were recorded. Adjustment for each baseline variable was made separately.


RESULTS
A total of 646 patients were identified: 313 PCI and 333 CABG. At 6 months, data were available for 88% of PCI and 96% of CABG patients (P=0.07) and at 12 months for 90% of PCI and 97% of CABG patients. Death, myocardial infarction or stroke were less frequent in CABG than in PCI patients (odds ratio (OR)=0.40, 95% confidence interval (CI)=0.21-0.85, P=0.01). Death, myocardial infarction, stroke, re-intervention and recurrent angina were also less frequent in CABG than in PCI patients (OR=0.16, 95% CI=0.10-0.26, P<0.001). The effect remained significant after all adjustments for baseline variables. Similar results were found at 12 months.


CONCLUSIONS
CABG is associated with improved major adverse cardiovascular and cerebrovascular events in patients with three-vessel and/or left main stem disease compared with PCI at 6 and 12 months. Our results indicate that, in the era of exponential growth of stents in patients with three-vessel disease, outcome will improve if patients are discussed in multidisciplinary meetings where the best treatment option can be chosen.
Biryukova
Evgenia
E
Departments of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK.
Williams
Frances M
FM
Valencia
Oswaldo
O
Kaski
Juan Carlos
JC
Bland
Martin
M
Jahangiri
Marjan
M
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome