Introduction: There is limited data comparing percutaneous coronary intervention (PCI) using second generation drug eluting stents (DES) with coronary artery bypass grafting (CABG) for treatment of multivessel coronary artery disease. The purpose of this study was to compare the clinical outcomes of PCI with second generation DES and CABG for patients with multivessel coronary artery disease.
Methods: The study comprised of 1415 CABG patients propensity matched with 1415 patients who had PCI with second generation DES. In-hospital major adverse cardiac events (MACE), stroke rate as well as 1-, 3-, and 5-year survival, were retrospectively compared. Median follow-up duration was 933 days (interquartile range 414 to 1845).
Results: In hospital re-intervention (p=0.118), mortality (p=0.780) and overall MACE (p=0.220) were similar for the two groups. There was a significantly higher incidence of in-hospital stroke for CABG patients (p=0.002). At median follow-up crude all-cause mortality was significantly higher for patients undergoing PCI (OR 1.63, 95%CI 1.31 to 2.04, p<0.001) (Figure). After adjustment for unadjusted confounders (previous PCI, left ventricular function, smoking, hypertension, renal disease and significant left main disease) there was still a significantly higher all-cause mortality for patients undergoing PCI (OR 1.68, 95% CI 1.2 to 2.35, p=0.002).
Conclusions: In patients with multivessel coronary artery disease, CABG offers superior survival advantage compared with PCI using second generation DES. Longer follow-up with evaluation in a randomized setting will further substantiate the results of this study.