title: Propensity score analysis of 10-year long-term outcome after bypass surgery or plain old balloon angioplasty in patients with metabolic syndrome.
abstract: Clinical hard outcomes (death and myocardial infarction) between bypass surgery (CABG) and percutaneous coronary intervention (PCI) are generally similar, whereas target vessel revascularization and angina relief are often superior with CABG.  However, there are no data regarding 10-year long-term clinical outcomes between the two procedures in metabolic syndrome (MetS). The aim of this study was to assess the long-term outcomes of CABG and plain old balloon angioplasty (POBA) in MetS patients. We enrolled 869 patients, 318 (36.6%) and 551 (63.4%) of whom underwent POBA and CABG, respectively. During follow-up (10.1 ± 3.5 years), 221 patients died (118 cardiovascular deaths) and 256 underwent revascularization. We predicted the probability of undergoing CABG using propensity analysis. Unadjusted survival was significantly lower in the CABG group because of unfavorable baseline characteristics. After adjusting for baseline variables including propensity score, POBA and CABG did not differ in terms of all cause (hazard ratio [HR] of CABG, 1.46; P = 0.132) and cardiovascular mortality (HR of CABG, 1.11; P = 0.757). However, the risk of subsequent revascularization was significantly lower in the CABG group than in the POBA group (HR of CABG, 0.15; P < 0.001). This study demonstrated that CABG is superior to POBA in terms of target vessel revascularization in MetS patients, whereas there were no significant differences in mortality after adjusting for baseline variables including propensity score.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine,Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yaginuma
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Kan
authors.initials: K
authors.lastname: Kajimoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors