title: Comparison of Five-Year Outcome of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Triple-Vessel Coronary Artery Disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2).
abstract: Studies evaluating long-term (≥5 years) outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD) are still limited. We identified 2,978 patients with TVD (PCI: n = 1,824, CABG: n = 1,154) of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2. The primary outcome measure in the present analysis was a composite of death, myocardial infarction (MI), and stroke. Median follow-up duration for the surviving patients was 1,973 days (interquartile range 1,700 to 2,244). The cumulative 5-year incidence of death/MI/stroke was significantly higher in the PCI group than in the CABG group (28.2% vs 24.0%, log-rank p = 0.006). After adjusting for confounders, the excess risk of PCI relative to CABG for death/MI/stroke remained significant (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.13 to 1.68, p = 0.002). The excess risks of PCI relative to CABG for all-cause death, MI, and any coronary revascularization were also significant (HR 1.38, 95% CI 1.10 to 1.74, p = 0.006; HR 2.81, 95% CI 1.69 to 4.66, p <0.001; and HR 4.10, 95% CI 3.32 to 5.06, p <0.001, respectively). The risk for stroke was not significantly different between the PCI and CABG groups (HR 0.88, 95% CI 0.61 to 1.26, p = 0.48). There were no interactions for the primary outcome measure between the mode of revascularization (PCI or CABG) and the subgroup factors such as age, diabetes, and Synergy Between PCI With Taxus and Cardiac Surgery score. In conclusion, CABG compared with PCI was associated with better long-term outcome in patients with TVD.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Department of Cardiology, Tenri Hospital, Nara, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Hanyu
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Mitsuomi
authors.initials: M
authors.lastname: Shimamoto
authors.affiliation: Department of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiwaki
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome