Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

• Main Authors: Tonga Nfor, Kambiz Shetabi, Wael Hassan, Quinta Nfor, Jayant Khitha, Anjan Gupta, Tanvir Bajwa, Suhail Allaqaband
• Format: Article
• Language: English
• Published: Aurora Health Care 2015-08-01
• Series: Journal of Patient-Centered Research and Reviews
• Subjects: high risk; three-vessel disease; left main; Heart Team; stenting; coronary artery bypass grafting
• Online Access: http://digitalrepository.aurorahealthcare.org/cgi/viewcontent.cgi?article=1045&context=jpcrr

Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P<0.001) and had shorter hospital stays (5.6 ± 5.7 days vs. 15.1 ± 10.6 days, P<0.001). Conclusions: The composite rate of death, myocardial infarction or stroke is similar for PCI and CABG in patients with symptomatic LM-3VD who have STS-predicted operative mortality > 5%.