Key result
CABG and PCI demonstrated a similar competing risk-adjusted probability for cardiac death (10.0% vs 9.3%) after a median 10.8 years of follow-up.
Why the study?
Does CABG compared to PCI improve long-term cardiac outcomes when accounting for competing risks of non-cardiac death in patients undergoing first-time non-emergent revascularization?
Cohort (n=1,234)
Does CABG compared to PCI improve long-term cardiac outcomes when accounting for competing risks of non-cardiac death in patients undergoing first-time non-emergent revascularization?
When adjusting for competing risks of non-cardiac death over 10 years, CABG and PCI have similar rates of cardiac death, though CABG is associated with lower rates of AMI but higher rates of CHF.
Similar cardiac mortality with CABG or PCI after competing-risk adjustment; extends observational data but should not yet change practice.
OBJECTIVES: To evaluate the influence of competing risk (CR) non-cardiac death during long-term follow-up of revascularized patients on the interpretation of the cardiac outcomes. METHODS: Retrospectively, we compared outcomes estimated with the Kaplan-Meier and the cumulative incidence function (CIF) methods after a median 10.8 years follow-up in 1,234 consecutive patients (594 CABG, 640 PCI) undergoing first time non-emergent revascularization in a community cohort. RESULTS: Overall 301 (24.4%) patients died (27.3% in the CABG vs. 21.7% in the PCI group, p = 0.02). The causes of death were cardiac (10.3%) and non-cardiac (14.1%). CR analysis showed a similar probability of cardiac death (CIF 0.10 (95% CI 0.092, 0.18) vs. 0.093 (0.07, 0.12)) in the CABG and PCI treated patients, respectively. The probability for acute myocardial infarction (CIF 0.12 vs. 0.16 p < 0.001), congestive heart failure (CIF 0.15 vs. 0.09 p = 0.007) in the CABG and PCI group respectively, differed. The differences were also statistically significant after multivariate adjustment for the competing risks of death. For all outcomes the Kaplan-Meier method overestimated risk estimates. CONCLUSIONS: The competing risk adjusted probability for cardiac death, but not other cardiac endpoints are comparable in patients treated with either CABG or PCI after very long-term follow-up. The risk for all-cause death was mainly predicted by the occurrence of non-cardiac diseases.
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Melberg et al. (2010) conducted a cohort in first time non-emergent revascularization (n=1,234). CABG vs. PCI was evaluated on Cardiac death. CABG and PCI demonstrated a similar competing risk-adjusted probability for cardiac death (10.0% vs 9.3%) after a median 10.8 years of follow-up.
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