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CABG confers better long-term results vs. PCI in younger patients with severe CAD

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Wael I. Awad

Young patients with three-vessel CAD had better long-term outcomes with CABG compared with PCI, according to results presented at the Society of Thoracic Surgeons Annual Meeting.

There was little difference over time between CABG and PCI in long-term outcomes for patients with one- or two-vessel disease, researchers reported.

The researchers undertook the study because “there are no long-term data about how best to manage young patients with coronary artery disease,” Wael I. Awad, FRCS, consultant cardiothoracic surgeon at St. Bartholomew’s Hospital, London, told Cardiology Today’s Intervention.

Awad and colleagues conducted a retrospective cohort study of 100 consecutive patients undergoing PCI and 100 consecutive patients undergoing CABG during 2004 at a single center. All patients were aged 50 years or younger (mean, 45 years) at the time of their procedure and were followed up at 5 and 12 years.

The primary endpoint was MACCE, defined as all-cause mortality, stroke, MI or repeat revascularization.

Patients who underwent CABG were more likely to have diabetes (35% vs. 22%), left ventricular ejection fraction less than 50% (19% vs. 9%), peripheral vascular disease (7% vs. 0%) and three-vessel (79% vs. 22%) or left main (30% vs. 3%) disease.

At 5 years, MACCE was greater in the PCI group (34 vs. 12; P < .01), as was MI (9% vs. 1%; P = .03) and repeat revascularization (31% vs. 7%; P < .01), Awad and colleagues found.

At 12 years, the PCI group still had greater incidence repeat revascularization (41.1% vs. 20.4%; P < .01), they found. MI was numerically greater in the PCI group (27.4% vs. 19.4%; P = .19), as was MACCE score (51 vs. 40; P = .07).

In patients with one- or two-vessel CAD, there were no differences between the groups in any outcome at either follow-up period.

However, in patients with three-vessel CAD, outcomes were worse in those who had PCI vs. CABG (MACCE: PCI group, 19 events in 21 patients; CABG group, 31 events in 78 patients; MI: PCI group, 47.6%; CABG group, 19.2%; repeat revascularization: PCI group, 66.7%; CABG group, 20.5%; P < .01 for all endpoints), according to the researchers.

“The results seem to fit with what is generally reported in the literature, but now confirm that the same applies to young patients, in that those with more severe coronary artery disease do better with surgery,” Awad told Cardiology Today’s Intervention. “Young patients should be presented with the evidence and take part in the decision-making process, and I suspect more young patients with more severe disease will opt for surgery.” – by Erik Swain

Reference:

Shafi AM, et al. Adult Cardiac: Ischemic. Presented at: Society of Thoracic Surgeons Annual Meeting; Jan. 27-31, 2018; Fort Lauderdale, Fla.

Disclosure: Awad reports no relevant financial disclosures.