title: CABG Versus PCI: Greater Benefit in Long-Term Outcomes With Multiple Arterial Bypass Grafting.
abstract: BACKGROUND
  Treatment of multivessel coronary artery disease with traditional single-arterial coronary artery bypass graft (SA-CABG) has been associated with superior intermediate-term survival and reintervention compared with percutaneous coronary intervention (PCI) using either bare-metal stents (BMS) or drug-eluting stents (DES).
  
  
  OBJECTIVE
  This study sought to investigate longer-term outcomes including the potential added advantage of multiarterial coronary artery bypass graft (MA-CABG).
  
  
  METHODS
  We studied 8,402 single-institution, primary revascularization, multivessel coronary artery disease patients: 2,207 BMS-PCI (age 66.6 ± 11.9 years); 2,381 DES-PCI (age 65.9 ± 11.7 years); 2,289 SA-CABG (age 69.3 ± 9.0 years); and 1,525 MA-CABG (age 58.3 ± 8.7 years). Patients with myocardial infarction within 24 h, shock, or left main stents were excluded. Kaplan-Meier analysis and Cox regression were used to separately compare 9-year all-cause mortality and unplanned reintervention for BMS-PCI and DES-PCI to respective propensity-matched SA-CABG and MA-CABG cohorts.
  
  
  RESULTS
  BMS-PCI was associated with worse survival than SA-CABG, especially from 0 to 7 years (p = 0.015) and to a greater extent than MA-CABG was (9-year follow-up: 76.3% vs. 86.9%; p < 0.001). The surgery-to-BMS-PCI hazard ratios (HR) were as follows: versus SA-CABG, HR: 0.87; and versus MA-CABG, HR: 0.38. DES-PCI showed similar survival to SA-CABG except for a modest 0 to 3 years surgery advantage (HR: 1.06; p = 0.615). Compared with MA-CABG, DES-PCI exhibited worse survival at 5 (86.3% vs. 95.6%) and 9 (82.8% vs. 89.8%) years (HR: 0.45; p <0.001). Reintervention was substantially worse with PCI for all comparisons (all p <0.001).
  
  
  CONCLUSIONS
  Multiarterial surgical revascularization, compared with either BMS-PCI or DES-PCI, resulted in substantially enhanced death and reintervention-free survival. Accordingly, MA-CABG represents the optimal therapy for multivessel coronary artery disease and should be enthusiastically adopted by multidisciplinary heart teams as the best evidence-based therapy.
authors.affiliation: Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Outcomes Research Unit, American University of Beirut, Beirut, Lebanon; Vascular Medicine Program, American University of Beirut, Beirut, Lebanon. Electronic address: rh106@aub.edu.lb.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Habib
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel Medical Center, New York, New York.
authors.forename: Kamellia R
authors.initials: KR
authors.lastname: Dimitrova
authors.affiliation: Outcomes Research Unit, American University of Beirut, Beirut, Lebanon.
authors.forename: Sanaa A
authors.initials: SA
authors.lastname: Badour
authors.affiliation: Outcomes Research Unit, American University of Beirut, Beirut, Lebanon.
authors.forename: Maroun B
authors.initials: MB
authors.lastname: Yammine
authors.affiliation: Outcomes Research Unit, American University of Beirut, Beirut, Lebanon.
authors.forename: Abdul-Karim M
authors.initials: AK
authors.lastname: El-Hage-Sleiman
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel Medical Center, New York, New York.
authors.forename: Darryl M
authors.initials: DM
authors.lastname: Hoffman
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel Medical Center, New York, New York.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Geller
authors.affiliation: Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schwann
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel Medical Center, New York, New York. Electronic address: rtranbau@chpnet.org.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality / Q000639:trends*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality / Q000639:trends*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: arterial grafting; coronary stents; myocardial revascularization; propensity matching