Mortality Outcome Post-MI after PCI and CABG Interventions

Q: What are the key findings of this study?

Coronary artery bypass grafting was not significantly associated with a higher hazard of three-year all-cause mortality compared to percutaneous coronary intervention in older patients post-myocardial infarction (aHR 1.12).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (MI) (n=6786). Intervention: Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI). Primary outcome: Three-year all-cause mortality (aHR 1.12, 95% CI 0.93-1.35, p=0.280).

Q: What does this research mean for the field?

Coronary artery bypass grafting is not significantly associated with a higher hazard of three-year all-cause mortality compared to percutaneous coronary intervention in post-myocardial infarction patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mina Muayad Alwan Al-Naqdi; Mohammed Lateef Mohammed Alkhammasi; Bassam Muayad Alwan Al-Naqdi

doi:10.5334/gh.1556

January 1, 2026Global HeartOpen Access

Mortality Outcome Post-MI after PCI and CABG Interventions

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Key result

CABG is not linked to higher three-year mortality than PCI in older patients post-MI.

aHR 1.12
95% CI 0.93-1.35
P=0.280
n=6,786

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Why the study?

Does CABG improve three-year all-cause mortality compared to PCI in post-MI patients aged ≥50 years?

Key Points

To compare three-year all-cause mortality and identify primary causes of death among post-myocardial infarction patients undergoing percutaneous coronary intervention versus coronary artery bypass grafting.
Registry-based retrospective cohort study evaluating 3,542 PCI patients and 3,244 CABG patients treated post-MI between 2020 and 2024 at two hospitals in Baghdad.
Survival outcomes were evaluated using Kaplan–Meier curves (log-rank test) and multivariable Cox proportional hazards regression adjusting for baseline demographic and clinical covariates.
Crude observed three-year mortality was 7.99% for PCI versus 11.19% for CABG, with unadjusted three-year Kaplan–Meier survival probabilities of 91.8% and 87.4%, respectively (log-rank p < 0.001).
After adjusting for baseline covariates, three-year all-cause mortality did not significantly differ between CABG and PCI (aHR = 1.12, 95% CI = 0.93–1.35, p = 0.280).
Non-cardiovascular conditions accounted for the majority of deaths (56.06% post-PCI and 50.11% post-CABG), while age (aHR = 1.04 per year), diabetes mellitus (aHR = 1.45), and renal complications (aHR = 1.70) independently predicted mortality.

Study Design

Type

Cohort (n=6,786)

Multicenter

Yes

Structured PICO

Does CABG improve three-year all-cause mortality compared to PCI in post-MI patients aged ≥50 years?

P

Population

6,786 patients aged 50 years and older hospitalized with acute myocardial infarction who underwent PCI or CABG, followed for up to 3 years.

E

Exposure

Coronary artery bypass grafting (CABG) performed as the primary intervention during the index hospitalization for acute MI

C

Comparator

Percutaneous coronary intervention (PCI) performed as the primary intervention during the index hospitalization for acute MI

O

Outcome

Three-year all-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.12 (95% CI 0.93–1.35)

Absolute Event Rate: 11.19% vs 7.99%

p-value: p=0.280

In a real-world cohort of post-MI patients, adjusted three-year all-cause mortality was not significantly different between those undergoing CABG versus PCI, supporting individualized heart-team decision-making.

Limitations

Observational design introduces potential for residual confounding despite multivariable adjustment.
Specific causes of death were unavailable for a small percentage of patients.
Angiographic complexity scores (such as SYNTAX score) were not available to further stratify comparative efficacy.
Treatment assignment was not randomized, indicating potential confounding by indication.
Exclusion of 589 patients with unconfirmed survival status may have introduced selection bias.
Results from two major tertiary centers may not be generalizable to centers with lower procedural volumes.
Not formally designed or powered as a non-inferiority or equivalence trial.
Potential confounding by indication
Unmeasured variables beyond those captured in the baseline registry
Exclusion of 589 patients who declined follow-up participation, introducing potential selection bias

Implication

Comparable mortality after PCI or CABG post-MI; leaves open optimal strategy pending randomized evidence.

Abstract

Background and Aim: Worldwide, heart-related conditions, including myocardial infarction (MI), persist as the leading cause of morbidity and mortality. The aim is to compare three-year mortality outcomes and identify causes of death among post-MI patients who received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: This registry-based retrospective cohort with follow-up study analyzed data from 3,542 PCI and 3,244 CABG patients treated post-MI between 2020 and 2024 in two hospitals in Baghdad. Kaplan–Meier curves (log-rank test) were used for unadjusted comparison. Cox proportional hazards regression was employed to compare three-year all-cause mortality, adjusting for baseline demographic and clinical covariates. Results: Baseline characteristics differed significantly, with CABG patients being older and having a higher prevalence of certain risk factors. Crude observed mortality during available follow-up was 7.99% for PCI and 11.19% for CABG; Kaplan–Meier analysis showed significantly different unadjusted survival distributions by log-rank test. However, after adjusting for baseline covariates, there was no significant difference in the hazard of three-year all-cause mortality between patients undergoing CABG and PCI (adjusted hazard ratio [aHR] = 1.12, 95% CI = 0.93–1.35, p = 0.280). Significant independent predictors of mortality included age (aHR = 1.04 per year), diabetes mellitus (aHR = 1.45), and renal complications (aHR = 1.70). Non-cardiovascular causes accounted for the majority of deaths in both groups (56.06% post-PCI, 50.11% post-CABG). Conclusion: In this observational cohort, adjusted three-year mortality was not significantly different between PCI and CABG, with non-cardiac causes accounting for the largest proportion of deaths. Due to potential confounding by indication, these findings represent observational associations rather than clinical equivalence. Both remain vital revascularization strategies, with selection guided by individualized heart-team assessment.

Discussion

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Cite This Study

Al-Naqdi et al. (2026) conducted a cohort in Acute myocardial infarction (MI) (n=6,786). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on Three-year all-cause mortality (aHR 1.12, 95% CI 0.93-1.35, p=0.280). Coronary artery bypass grafting was not significantly associated with a higher hazard of three-year all-cause mortality compared to percutaneous coronary intervention in older patients post-myocardial infarction (aHR 1.12).

synapsesocial.com/papers/6a2ba31a8101cf8926f01f56 https://doi.org/10.5334/gh.1556

Topics

Percutaneous coronary intervention

Chronic total occlusion PCI

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Mortality Outcome Post-MI after PCI and CABG Interventions

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Mortality Outcome Post-MI after PCI and CABG Interventions

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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