Coronary artery bypass graft surgery versus drug-eluting stent implantation for high-surgical-risk patients with left main or multivessel coronary artery disease.
OBJECTIVE
There are limited data comparing long-term outcomes of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with high surgical risk. We evaluated 5-year outcomes following CABG versus PCI with DES in 598 patients with left main or multivessel coronary artery disease (CAD) and a high surgical risk [EuroSCORE (European system for cardiac operative risk evaluation) ≥ 6].


METHODS
Databases were merged from the BEST, PRECOMBAT and SYNTAX trials. The primary outcome was a major adverse cardio-cerebral event (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke or repeat revascularization.


RESULTS
During 5-year follow-up, the rates of MACCE were 29.4% in the CABG group and 43.8% in the PCI group [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49 - 0.84; P  = 0.001]. The MACCE was significantly better with CABG than with PCI in patients with high and intermediate SYNTAX scores (34.9% vs 46.3%, P  = 0.039, and 29.7% vs 47.6%, P  = 0.010, respectively), but comparable between the two groups in those with low SYNTAX scores. The rates of all-cause death and stroke were similar between the two groups. However, CABG was associated with fewer myocardial infarctions (HR, 0.50; 95% CI, 0.27 - 0.93; P  = 0.027) and repeat revascularizations (HR, 0.32; 95% CI, 0.20 - 0.52; P  < 0.001).


CONCLUSIONS
Among high surgical risk patients with left main or multivessel CAD, CABG compared to PCI with DES was associated with a lower rate of MACCE.
Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Mineok
M
Chang
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Cheol Whan
CW
Lee
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Jung-Min
JM
Ahn
Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Rafael
R
Cavalcante
Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Yohei
Y
Sotomi
Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Yoshinobu
Y
Onuma
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Duk-Woo
DW
Park
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Soo-Jin
SJ
Kang
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Seung-Whan
SW
Lee
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Young-Hak
YH
Kim
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Seong-Wook
SW
Park
Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.|International Center for Circulatory Health, Imperial College of London, London, UK.
Patrick W
PW
Serruys
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Seung-Jung
SJ
Park
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012306:Risk; D016896:Treatment Outcome
Coronary artery bypass graft surgery; Drug-eluting stents; EuroSCORE; Left main coronary artery disease; Multivessel disease