The effect of coronary revascularization timing on cardiovascular outcomes in patients with ischemic heart disease

Background There is little evidence on whether the timing of revascularization affects cardiovascular disease progression in patients with stable ischemic heart disease. We aimed to determine if disease progression differed between patients who underwent coronary artery bypass graft (CABG) surgery after the time recommended by physicians compared to timely percutaneous coronary intervention (PCI). Methods We identified 25,469 British Columbia, Canada residents ages 60 years or older who underwent their first non-emergency revascularization for angiographically proven, stable left main or multi-vessel ischemic heart disease. We estimated the cumulative incidence of a composite cardiovascular outcome (CVO) and death as a competing risk for patients undergoing delayed CABG versus timely PCI. Results After adjustment, patients who underwent delayed CABG had a statistically significantly lower cumulative CVO incidence at three years compared with those who received timely PCI (9.6% delayed CABG, 23.2% timely PCI; subdistribution hazard ratio for CVO at three years 0.50, 95% CI 0.26–0.99). Conclusion Our results suggest that for patients who wish to wait for CABG, doing so may lead to slower disease progression compared with receiving PCI.