Background: To compare the outcome including death, myocardial infarction, stroke, recurrent angina and need for re-intervention in patients with multivessel disease undergoing percutaneous intervention (PCI) or coronary artery bypass graft surgery (CABG). A 'real-world' evaluation of current practice in UK is lacking.
Methods: A retrospective and ongoing analysis of consecutive patients with three-vessel disease and/or left main stem undergoing PCI or CABG between September 2005 and December 2006 was carried out. In-hospital outcome and outcome measures at 6 and 12 months, including death, myocardial infarction, cerebrovascular events, recurrent angina and re-intervention were recorded. Adjustment for each baseline variable was made separately.
Results: A total of 646 patients were identified: 313 PCI and 333 CABG. At 6 months, data were available for 88% of PCI and 96% of CABG patients (P=0.07) and at 12 months for 90% of PCI and 97% of CABG patients. Death, myocardial infarction or stroke were less frequent in CABG than in PCI patients (odds ratio (OR)=0.40, 95% confidence interval (CI)=0.21-0.85, P=0.01). Death, myocardial infarction, stroke, re-intervention and recurrent angina were also less frequent in CABG than in PCI patients (OR=0.16, 95% CI=0.10-0.26, P<0.001). The effect remained significant after all adjustments for baseline variables. Similar results were found at 12 months.
Conclusions: CABG is associated with improved major adverse cardiovascular and cerebrovascular events in patients with three-vessel and/or left main stem disease compared with PCI at 6 and 12 months. Our results indicate that, in the era of exponential growth of stents in patients with three-vessel disease, outcome will improve if patients are discussed in multidisciplinary meetings where the best treatment option can be chosen.
Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.