Key result
Multivessel PCI is associated with similar 36-month major event risk compared to CABG.
Why the study?
There are no clinical trials comparing multivessel PCI with CABG in patients with severe CAD presenting with NSTE-ACS.
Does multivessel percutaneous coronary intervention improve outcomes compared to coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes?
Cohort (n=455)
Does multivessel percutaneous coronary intervention improve outcomes compared to coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes?
Hazard Ratio: 1.28 (95% CI 0.75–2.21)
p-value: p=0.36
MV PCI and CABG offer comparable long-term mortality and composite outcomes in severe CAD with NSTE-ACS, although MV PCI carries a higher risk of subsequent MI and repeat revascularization.
Comparable composite outcomes with multivessel PCI versus CABG in NSTE-ACS; leaves open need for RCTs to guide practice.
BACKGROUND: There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population. AIM: We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NSTE-ACS. METHODS: A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes. RESULTS: MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75-2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75-2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46-1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47-1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively). CONCLUSIONS: It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group.
No takes yet. Share an insight, caveat, or question.
Desperak et al. (2018) conducted a cohort in Severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (n=455). Multivessel percutaneous coronary intervention (MV PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven revascularisation, or stroke) (HR 1.28, 95% CI 0.75-2.21, p=0.36). Multivessel PCI was associated with a similar 36-month incidence of death, MI, revascularization, or stroke compared to CABG (HR 1.28; 95% CI 0.75-2.21; p=0.36).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: