Why the study?
Outcomes comparing CABG and PCI with new-generation drug-eluting stents in non-diabetic patients presenting with multivessel ACS and an intermediate SYNTAX score remained to be determined.
Does PCI with new-generation drug-eluting stents improve outcomes compared to CABG in non-diabetic patients with multivessel ACS and intermediate SYNTAX score?
Does PCI with new-generation drug-eluting stents improve outcomes compared to CABG in non-diabetic patients with multivessel ACS and intermediate SYNTAX score?
In non-diabetic patients with multivessel ACS and intermediate SYNTAX scores, PCI with new-generation DES yields similar 5-year mortality to CABG, with a higher need for repeat revascularization but a lower stroke risk.
Observational data in non-diabetic multivessel ACS should not yet change practice; leaves open optimal revascularization strategy pending randomized trials.
OBJECTIVE: Our main objective is to determine the difference between patients undergoing CABG and PCI with new-generation drug-eluting stents who were non-diabetic during the course of a multivessel acute coronary syndrome (ACS) and intermediate SYNTAX score. METHODS: Between 2012 and 2014, we retrospectively evaluated 1011 non-diabetic patients with ACS in a single center. The patients were followed up up to 5-years. All- cause mortality, cardiac death, myocardial infarction, stroke, revascularization and stent thrombosis were recorded accordingly. RESULTS: A total of 516 (51%) patients were included in the PCI group and 495 patients (49%) in the CABG group. Stroke occurrence (PCI group: 0.8%, and CABG group: 2.6%, p=0.022), requirement for recurrent revascularizations (PCI group: 13.6%, and CABG group: 8.1%, p=0.005) and the MACE percentage (PCI group: 20.3%, and CABG group: 14.5%, p=0.015) were statistically significant between two groups. However, there was no statistical significance difference between two groups in terms of primary endpoints including death, MI, and stroke (PCI group: 10.9%, and CABG group: 8.3%, p=0.165) and all-cause mortality PCI group 6.2%, and CABG group: 4.7%, p=0.298). CONCLUSION: There was no difference in all-cause mortality and myocardial infarction between the PCI and the CABG groups during 5-year follow-up. The frequency of repeated revascularizations was lower in the CABG group than the PCI group. In contrast, the stroke rates were higher in the CABG group.
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İbrahimov et al. (2020) studied this question.
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