Coronary artery bypass grafting (CABG) might be the better choice for the coronary revascularization of younger patients, based on better long-term results in one British center’s experience.
Those 50 years and younger getting CABG or percutaneous coronary intervention (PCI) had similar rates of stroke and mortality 5 years later, Wael Awad, MD, of St. Bartholomew’s Hospital in London, reported at the annual meeting of the Society of Thoracic Surgeons. However, other endpoints generally favored CABG at that point:
- MI: 9% PCI versus 1% CABG (P=0.02)
- Repeat revascularization: 31% versus 7% (P<0.01)
- Hospital readmission: 45% versus 10% (P<0.01)
- Overall major adverse events: 34% versus 12% (P<0.01)
At 12 years, the only differences persisting between groups still favored CABG, with higher rates in the PCI group of repeat revascularization (41.1% versus 20.4%, P<0.01) and hospital readmission (55.8% versus 36.7%, P<0.01). The gap between PCI and CABG narrowed to non-significance in terms of overall major adverse events (51% versus 40%, P=0.07).
Subgroup analysis showed it was the three-vessel disease group getting CABG that still had an advantage in repeat revascularizations (20.5% versus 66.7%, P<0.01) and MI (19.2% versus 47.6%, P<0.01).
“CABG should remain the preferred method of revascularization in young patients with three-vessel disease,” they concluded.
The investigators had performed a retrospective analysis of 100 consecutive stented patients and 100 consecutive CABG patients presenting at their institution in 2004, excluding those with previous PCI or CABG.
Statistically significant differences between groups at baseline included lower LV ejection fraction and more multivessel disease among CABG recipients. This group got 90% complete revascularization with surgery and had an average hospital stay of 6.6 days.
Meanwhile, 44% of the PCI group achieved complete revascularization and stayed in the hospital stay for an average 2.4 days.
Previous studies comparing stenting to surgery have been “inherently biased against the prognostic benefit of surgery” because low-risk patients — who tend to have one- or two-vessel disease with normal left ventricular (LV) function — outnumber high-risk individuals, Awad suggested.
Interventionalist Ajay Kirtane, MD, of New York-Presbyterian/Columbia University Medical Center in New York City, suggested to MedPage Today that he was not moved by the study’s findings.
“Unfortunately this study is non-randomized and because it draws upon a limited number of patients from a single center, it is impossible to draw firm conclusions from it. A significant proportion of the PCI population was treated with bare metal stents, and there are many elements that suggest that the two groups are not truly comparable,” he said. “Given the study limitations, I personally do not find the results all that helpful with respect to current practice.”
Awad disclosed no relationships with industry.
Kirtane disclosed institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Spectranetics