Key result
PCI is linked to ~23% higher MACE risk versus CABG in young multivessel ACS.
Why the study?
The management of ACS in young patients with multivessel disease remains unclear despite their long life expectancy and increasing incidence of premature ACS.
Does coronary artery bypass graft surgery reduce major adverse cardiovascular events and costs compared to percutaneous coronary intervention in young individuals (≤55 years) with acute coronary syndromes and multivessel disease?
Cohort (n=1,088)
Yes
Does coronary artery bypass graft surgery reduce major adverse cardiovascular events and costs compared to percutaneous coronary intervention in young individuals (≤55 years) with acute coronary syndromes and multivessel disease?
Hazard Ratio: 1.227 (95% CI 1.004–1.499)
Absolute Event Rate: 28.8% vs 20.7%
p-value: p=0.0457
In young patients (≤55 years) with ACS and multivessel disease, CABG is associated with lower long-term MACE and reduced indirect costs compared to PCI.
CABG was associated with lower long-term MACE and indirect costs than PCI in young ACS with multivessel disease; leaves open optimal strategy pending randomized data.
Background In recent decades, the world watched a dramatic increase in the incidence of acute coronary syndromes (ACS) among young individuals (≤55 years-old) and a relative decrease in the elderly. The management of ACS in young patients with multivessel disease still needs to be elucidated, as these individuals maintain a long life expectancy. Research Question To compare clinical outcomes and care costs in individuals with premature ACS and multivessel disease undergoing coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Methods and Results Participants included all individuals ≤55 years-old admitted with ACS to public hospitals in Brasília (Brazil) between 2013 and 2015 and who underwent cardiac catheterization with SYNTAX score ≥23 or Duke category 6. Outcomes were adjudicated with death certificates and data from medical records. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), defined as death due to cardiovascular causes, recurrent hospitalizations due to cardiovascular ischemic events, and incident heart failure New York Heart Association III-IV. As secondary outcome we assessed indirect and direct costs by evaluating the cost of lost productivity (in international dollars (Int$) per year) due to illness and death, outpatient costs and costs with new hospitalizations. Multivariate and principal components (PC) adjusted analyzes were performed. Results Among 1,088 subjects (111 CABG and 977 PCI) followed for 6.2 years (IQR: 1.1), 304 primary events were observed. MACE was observed in 20.7% of the CABG group and 28.8% of the PCI group ( p = 0.037). In multivariate analyses, PCI was associated with a hazard ratio (HR) = 1.227 (95% CI: 1.004–1.499; p = 0.0457) for MACE, and in PC-adjusted HR = 1.268 (95% CI: 1.048–1.548; p = 0.0271) compared with CABG. Despite direct costs were equivalent, the cost due to the loss of labor productivity was higher in the PCI group (Int$ 4,511 (IQR: 18,062)/year vs Int$ 3,578 (IQR: 13,198)/year; p = 0.049], compared with CABG. Conclusions Among young individuals with ACS and multivessel disease, surgical strategy was associated with a lower occurrence of MACE and lower indirect costs in the long-term.
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Alexim et al. (2022) conducted a cohort in Acute coronary syndromes and multivessel disease (n=1,088). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass graft (CABG) was evaluated on Major adverse cardiovascular events (MACE) (HR 1.227, 95% CI 1.004-1.499, p=0.0457). Percutaneous coronary intervention was associated with a 22.7% higher risk of major adverse cardiovascular events compared to coronary artery bypass grafting in young individuals with acute coronary syndromes and multivessel disease.
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