Key result
In patients ≤50 years, percutaneous coronary intervention was associated with a higher rate of MACCE at 5 years compared to CABG (34% vs 12%, P<0.01), driven by patients with 3-vessel disease.
Why the study?
Young patients with coronary artery disease primarily undergo PCI to defer CABG, but the validity of this approach required investigation.
Does PCI compared to CABG reduce MACCE in patients ≤50 years with coronary artery disease?
Cohort (n=200)
Does PCI compared to CABG reduce MACCE in patients ≤50 years with coronary artery disease?
Absolute Event Rate: 34% vs 12%
p-value: p=<.01
CABG remains the preferred revascularization strategy over PCI in young patients (≤50 years) with 3-vessel coronary artery disease due to lower rates of MACCE, MI, and repeat revascularization.
May support CABG over PCI in young patients with 3-vessel disease; leaves open need for randomized confirmation.
BACKGROUND: Young patients with coronary artery disease are undergoing percutaneous coronary intervention (PCI) primarily, with a view to deferring coronary artery bypass grafting (CABG). We investigated the validity of this approach, by comparing outcomes in patients ≤50 years undergoing CABG or PCI. METHODS: One hundred consecutive patients undergoing PCI and 100 undergoing CABG in 2004 were retrospectively studied to allow for 5 and 12 years follow-up. The two groups were compared for the primary endpoints of major adverse cardiac or cerebrovascular event (MACCE). RESULTS: Diabetes, peripheral vascular disease, and left ventricular ejection fraction <50% were higher in the CABG group. At 5 years, rates of myocardial infarction (MI) (9% vs 1%, P = .02), repeat revascularization (31% vs 7%, P < .01), and MACCE (34 vs 12, P < .01) were greater in the PCI vs the CABG group. Similarly, at 12 years, rates of MI (27.4% vs 19.4%, P = .19), repeat revascularization (41.1% vs 20.4%, P < .01), and MACCE (51 vs 40, P = .07) were greater in the PCI group. There were no differences in major outcomes in patients with 1 or 2VD, at 5 or 12 years. Rates of MI, revascularization, and MACCE were higher in patients with 3VD undergoing PCI (n = 21; MI, 47.6%; revascularization, 66.7%; and MACCE, 19 events) vs CABG (n = 78; MI, 19.2%; revascularization, 20.5%; and MACCE, 31 events); P < .01, for all end points. CONCLUSIONS: MACCE was lower in young patients undergoing CABG vs PCI at both 5 and 12 years follow-up, primarily as a consequence of patients with 3VD undergoing PCI having more MI and repeat revascularization. CABG should remain the preferred method of revascularization in young patients with 3VD.
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Shafì et al. (2019) conducted a cohort in Coronary artery disease (n=200). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Major adverse cardiac or cerebrovascular event (MACCE) at 5 years (p=<.01). In patients ≤50 years, percutaneous coronary intervention was associated with a higher rate of MACCE at 5 years compared to CABG (34% vs 12%, P<0.01), driven by patients with 3-vessel disease.
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