Key result
Percutaneous coronary intervention was associated with lower adjusted in-hospital mortality (7.6% vs 18.8%) compared to coronary artery bypass surgery for STEMI due to unprotected left main disease.
Why the study?
Comparative outcomes for percutaneous coronary intervention versus CABG surgery for left main coronary artery disease remain limited from a large national database.
Does PCI reduce in-hospital mortality and adverse events compared to CABG in patients with STEMI due to unprotected left main disease?
Cohort (n=1,465)
Yes
Does PCI reduce in-hospital mortality and adverse events compared to CABG in patients with STEMI due to unprotected left main disease?
Absolute Event Rate: 7.6% vs 18.8%
In patients presenting with STEMI due to unprotected left main disease, PCI is associated with lower in-hospital mortality, higher rates of discharge to home, and lower costs compared to CABG.
PCI should not yet change practice in STEMI with unprotected left main disease; leaves open need for randomized trials.
Introduction: Comparative outcomes for percutaneous coronary intervention versus CABG surgery for left main coronary artery disease remains limited from a large national database. Methods: We studied comparative outcomes of PCI versus CABG using the US national inpatient sample database from 2015 to 2018 for left main disease presenting as STEMI. Results: A total of 930 and 535 patients with STEMI underwent PCI and CABG respectively. The patients undergoing PCI were older (67.5 years [Interquartile range (IQR),59-77]vs 67 [59-74]). Adjusted mortality was much higher in CABG (18.80%) as compared to PCI (7.6%). Higher percentage of patients were discharged to home after PCI as compared to CABG (49.70% vs 27.60%). Conversely, as compared to PCI a higher number of patients undergoing CABG were discharged to long-term care facility (71.90% VS 50.20%). Cost of care ($ 48703[IQR, 36803-71262] vs $ 30376 [19161-52207]) was considerably higher with CABG. The odds of in-hospital mortality and adverse events for CABG compared to PCI are depicted in figure 1. Conclusions: PCI may be associated with lower in-hospital mortality and adverse events when compared to CABG for unprotected left main disease.
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Zahid et al. (2021) conducted a cohort in STEMI due to unprotected left main disease (n=1,465). Percutaneous Coronary Intervention vs. Coronary Artery Bypass Surgery was evaluated on Adjusted in-hospital mortality. Percutaneous coronary intervention was associated with lower adjusted in-hospital mortality (7.6% vs 18.8%) compared to coronary artery bypass surgery for STEMI due to unprotected left main disease.
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