Very Long–Term (10 to 14 Year) Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in the Bare-Metal Stent Era

Abstract

Background— Many of the previous randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease reported equivalent or better survival with CABG as compared with PCI at 5-year follow-up. However, 5-year follow-up might be too short to evaluate the true differences in long-term clinical outcomes between PCI and CABG. Methods and Results— Among 8934 patients enrolled in the extended 10- to 14-year follow-up study of the CREDO-Kyoto registry cohort-1 (Coronary Revascularization Demonstrating Outcome study in Kyoto) conducted in the bare-metal stent era, 5152 (PCI: n=3490 and CABG: n=1662) patients had multivessel coronary artery disease without left main disease. Median follow-up duration was 11.2 (interquartile range: 10.2–12.2) years. The cumulative 10-year incidence of all-cause death was not significantly different between PCI and CABG (32.2% versus 31.7%; log-rank P =0.93). After adjusting for confounders, however, the mortality risk of PCI was significantly higher than that of CABG (hazard ratio, 1.19 [95% confidence interval, 1.02–1.39]; P =0.03). Within 5 years after the index procedure, the risk for all-cause death was significantly higher after PCI than after CABG (hazard ratio, 1.41; 95% CI, 1.12–1.79; P =0.004). By a landmark analysis at 5 years, however, the cumulative 10-year incidence of and adjusted risk for all-cause death beyond 5 years were not significantly different between PCI and CABG (19.3% versus 20.0%; log-rank P =0.22 and hazard ratio, 1.02, 95% confidence interval, 0.83–1.26; P =0.82). Conclusions— CABG as compared with PCI was associated with better 10-year survival in patients with multivessel coronary artery disease. However, the benefit of CABG compared with PCI on late mortality beyond 5 years was not observed in this study.

Interaction Between Treatment and Age or Sex in Non-ST-Segment Elevation Acute Coronary Disease and Three-Vessel Disease

“…Similar results were obtained in subgroups. Analyses restricted to patients with NSTE-ACS yield consistent results with our findings ( 15 ). On the contrary, other studies consisting of heterogeneous populations reported a more striking benefit of CABG in the elderly than in younger patients ( 15 , 23 – 25 ).…”

“…Analyses restricted to patients with NSTE-ACS yield consistent results with our findings ( 15 ). On the contrary, other studies consisting of heterogeneous populations reported a more striking benefit of CABG in the elderly than in younger patients ( 15 , 23 – 25 ). Notably, patients with NSTE-ACS were only accounted for <10–30% of the participants in these studies.…”

“…We also found a lower cardiac death rate achieved by CABG, although the all-cause death rate was comparable. Two observational studies reported a significant 10-year survival benefit with CABG over PCI ( 15 , 16 ), whereas other studies reported inconsistent results ( 17 , 18 ). CABG significantly reduces repeated revascularization when compared with PCI and has been a universal finding across manifestations of CAD.…”

Real world experience of GenXSync and trade; sirolimus eluting coronary stent system in patients with long coronary lesions: outcome of the GEL registry

“…The core-lab evaluation was performed by an independent core laboratory. Clinical follow-up was done at 1,6,8,12 and up to 24 months post-procedure. The study monitoring, data management and report including statistical analysis was performed by and Independent Contract Research Organization.…”

“…1 Since the introduction of balloon angioplasty in 1970s, PCI has undergone significant advancement with the introduction of bare-metal stents and now, the drug-eluting stents (DES). Though the first generation DES drastically reduced restenosis, concerns with their long-term safety persist.…”