Composite outcomes in coronary bypass surgery versus percutaneous intervention.
BACKGROUND
Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation.


METHODS
CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors.


RESULTS
There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83).


CONCLUSIONS
The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.
The Society of Thoracic Surgeons, Chicago, Illinois. Electronic address: fred.edwards@jax.ufl.edu.
Fred H
FH
Edwards
Massachusetts General Hospital, Boston, Massachusetts.
David M
DM
Shahian
Duke Clinical Research Institute, Durham, North Carolina.
Maria V
MV
Grau-Sepulveda
University of Colorado School of Medicine, Aurora, Colorado.
Frederick L
FL
Grover
Children's Hospital Boston, Boston, Massachusetts.
John E
JE
Mayer
Duke Clinical Research Institute, Durham, North Carolina.
Sean M
SM
O'Brien
Duke Clinical Research Institute, Durham, North Carolina.
Elizabeth
E
DeLong
Duke Clinical Research Institute, Durham, North Carolina.
Eric D
ED
Peterson
Harbor-UCLA Medical Center, Torrance, California.
Charles
C
McKay
California Pacific Medical Center, San Francisco, California.
Richard E
RE
Shaw
Lenox Hill Heart and Vascular Institute of New York, New York, New York.
Kirk N
KN
Garratt
Mount Sinai Medical Center, New York, New York.
George D
GD
Dangas
University of Colorado School of Medicine, Aurora, Colorado.
John
J
Messenger
Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Lloyd W
LW
Klein
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Jeffrey J
JJ
Popma
Christiana Care Center for Outcome Research, Newark, Delaware.
William S
WS
Weintraub
D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011379:Prognosis; D020521:Stroke / Q000209:etiology