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CABG lowered mortality risk vs. PCI in multivessel disease
Results of a propensity score-match study show that CABG is associated with lower long-term mortality than PCI in patients with multivessel disease, with better survival rates observed in patients with diabetes, HF, peripheral arterial disease, or those who used tobacco.
To assess whether clinical characteristics modify the comparative effectiveness of CABG vs. PCI in an unselected, general patient population, Mark A. Hlatky, MD, and researchers conducted an observational treatment comparison between the two treatments using propensity score matching and Cox proportional hazards models among Medicare beneficiaries aged 66 years and older from 1992 to 2008.
Among 105,156 propensity score-matched patients with multivessel disease, CABG was associated with lower mortality than PCI (HR=0.92; 95% CI, 0.90-0.95). CABG led to lower rates of mortality among patients with diabetes (HR=0.88), a history of tobacco use (HR=0.82), HF (HR=0.84) and PAD (HR=0.85). The overall predicted difference in survival between the two treatments over 5 years was 0.053 life-years (range, –0.017 to 0.579; P<.001). Patients with diabetes, HF, PAD or who used tobacco had the largest predicted differences in survival after CABG, and those with none of these factors had slightly better survival after PCI.
Mark A. Hlatky
Hlatky and colleagues wrote that the study provides strong evidence that clinical characteristics modify the comparative effectiveness of CABG and PCI on mortality, especially for patients with diabetes.
“These variations in comparative effectiveness underscore the need to personalize treatment recommendations for coronary revascularization among patients with multivessel coronary disease,” they said.
Disclosure: The researchers report no relevant financial disclosures.