February 21, 2026American Journal of Preventive Cardiology0 citationsOpen Access
Ver artículo completoCoronary plaque burden as a determinant of cardiovascular outcomes in patients undergoing percutaneous coronary intervention versus coronary artery bypass grafting: The Western Denmark Heart Registry
Resultado clave
In patients with high coronary plaque burden (CAC>1000), CABG reduced the primary endpoint risk by 25% versus PCI (HR 0.75, 95% CI 0.58-0.94), mainly via MI reduction.
Puntos clave
- This study aims to evaluate how coronary artery calcification affects outcomes in CABG versus PCI for stable CAD patients.
- Conducted propensity-matched analyses among 85,512 symptomatic patients
- Matched CABG-treated patients with PCI-treated and non-obstructive CAD patients
- Utilized Cox proportional hazard models to assess risk for primary endpoint (death, myocardial infarction, stroke)
- 710 primary endpoints occurred over 5.3 years
- CABG patients had higher prevalence of three-vessel obstructive CAD compared to PCI patients
- Event rates increased with higher CAC scores, indicating rising risk levels
- CABG yielded lower long-term risk compared to PCI for patients with high plaque burden
PICO estructurado
Does CABG reduce the risk of death, myocardial infarction, or stroke compared to PCI in patients with stable CAD stratified by coronary artery calcification (CAC) burden?
P
Población
Symptomatic patients with stable coronary artery disease undergoing computed tomography angiography. Propensity-matched cohort of 1,479 CABG-treated patients matched 1:1:1 with PCI-treated patients and non-obstructive CAD patients (total matched n=4,437, drawn from an initial pool of 85,512 patients).
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Intervención
Coronary artery bypass grafting (CABG)
C
Comparador
Percutaneous coronary intervention (PCI) and non-obstructive CAD
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Resultado
Composite of death, myocardial infarction, or strokecomposite
In patients with stable CAD and high coronary plaque burden (CAC >1000), CABG is associated with a lower long-term risk of death, MI, or stroke compared to PCI.
Resultado numérico
Tasa de eventos absoluta: 0% vs 0%
Resumen
Benefits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for patients with stable coronary artery disease (CAD) may be determined by total plaque burden alongside number of stenoses. We aimed to determine whether coronary artery calcification (CAC), reflecting overall plaque burden, predicts CABG versus PCI benefits. Among 85,512 symptomatic patients undergoing computed tomography angiography, we conducted propensity-matched analyses. CABG-treated patients (n = 1,479) were 1:1:1 matched with PCI-treated patients and non-obstructive CAD patients. Cox proportional hazard models assessed risk for the primary endpoint (death, myocardial infarction, stroke), stratified by CAC1000. Over 5.3 years, 710 primary endpoints occurred. CABG patients had higher prevalence of three-vessel obstructive CAD compared to PCI-treated patients (30 %vs.18 %). Event rates rose with increasing CAC scores; CAC1000 indicated very-high risk. Patients with non-obstructive CAD had similar risk to PCI-revascularized patients across CAC groups. Compared to PCI, risk for the primary endpoint were lower at higher plaque burden in CABG-treated patients with hazard ratios of 1.12 (95 %CI 0.70-1.80), 0.82 (95 %CI 0.55-1.20), and 0.75 (95 %CI 0.58-0.94) for CAC1000, respectively. The lower CABG-associated risk was driven by reduced myocardial infarction risk (HR 0.44 (95 %CI 0.26-0.73)). Among patients with high, but not low, coronary plaque burden, CABG yielded lower long-term risk than PCI, despite more multivessel obstructive CAD. This suggest that the benefit of CABG over PCI for patients with extensive CAD can, at least partly, be attributed to the bypassing of a larger plaque burden. Among patients with high, but not low, coronary plaque burden as assessed by coronary artery calcification, revascularization with coronary artery bypass grafting is associated with lower long-term risk than percutaneous coronary intervention despite higher prevalence of multivessel obstructive disease.
Cite This Study
Mortensen et al. (Sun,) reported a other. In patients with high coronary plaque burden (CAC>1000), CABG reduced the primary endpoint risk by 25% versus PCI (HR 0.75, 95% CI 0.58-0.94), mainly via MI reduction.