PCI vs CABG shows similar rates of mortality but higher target-vessel revascularizations at 10 years
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.
This observational study of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization) registry assessed a total of 2,240 patients with unprotected LMCA disease who underwent PCI (n=1,102) or underwent CABG (n=1,138) between January 2000 and June 2006.
The authors compared the adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction or stroke, and target-vessel revascularization) using propensity scores and inverse-probability–weighting adjustment. Follow-up was extended to at least 10 years for all patients (median, 12.0 years).
No significant difference was found in adjusted risks of death and the composite outcome between the groups in the overall cohort up to 10 years. The PCI group had a significantly higher risk of target-vessel revascularization.
In the cohort comparing drug-eluting stents and concurrent CABG, there were no significant between-group differences in the risks of death and the composite outcome at 5 years. However, drug-eluting stents vs CABG correlated with higher risks of death (hazard ratio [HR], 1.35; 95 percent CI, 1.00–1.81) and the composite outcome (HR, 1.46; 1.10–1.94) after 5 years.
“Comparative outcomes of CABG and PCI for LMCA disease were previously reported. However, data on very long-term (>10 years) outcomes are limited,” the authors noted.