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Percutaneous coronary intervention versus coronary arterial bypass grafting in patients with multi‐vessel coronary revascularization (from the CREDO‐Kyoto PCI/CABG registry/cohort‐2)
Author(s) -
Watanabe Hiroki,
Shiomi Hiroki,
Morimoto Takeshi,
Furukawa Yutaka,
Nakagawa Yoshihisa,
Ando Kenji,
Kadota Kazushige,
Tazaki Junichi,
Watanabe Hirotoshi,
Natsuaki Masahiro,
Minatoya Kenji,
Hanyu Michiya,
Komiya Tatsuhiko,
Kimura Takeshi
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28420
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , myocardial infarction , revascularization , coronary artery disease , stroke (engine) , drug eluting stent , cumulative incidence , population , stent , cohort , mechanical engineering , environmental health , engineering
Objective To assess long‐term outcomes after percutaneous coronary intervention (PCI) with drug‐eluting stent only compared with coronary artery bypass grafting (CABG) in patients with triple‐vessel disease. Background Selection between PCI and CABG is still a clinically relevant issue in the management of patients with multi‐vessel coronary artery disease. Methods Among 15,939 patients enrolled in the CREDO‐Kyoto PCI/CABG registry/cohort‐2, the current study population consisted of 2,193 patients who underwent elective multi‐vessel coronary revascularization including left anterior descending coronary artery (LAD) either by PCI with sirolimus‐eluting stent (SES) only ( N = 945) or CABG ( N = 1,248). Results The cumulative 5‐year incidence of and the adjusted risk for the primary outcome measure (a composite of all‐cause death, myocardial infarction [MI], or stroke) were not significantly different between PCI and CABG groups (22.6% vs. 23.0%, p = .40, and HR: 1.13, 95%CI: 0.91–1.40, p = .26). The risk of PCI relative to CABG for all‐cause death and stroke was also insignificant (HR: 1.19, 95%CI: 0.92–1.53, p = .19; HR: 0.89, 95%CI: 0.62–1.27, p = .51). The adjusted 5‐year risk for MI, hospitalization for heart failure (HF), any coronary revascularization and major bleeding was significantly different between the groups (HR: 1.59, 95%CI: 1.10–2.30, p = .01; HR: 1.49, 95%CI: 1.05–2.11, p = .02; HR: 3.70, 95%CI: 2.91–4.70, p < .0001; HR: 0.18, 95%CI: 0.14–0.22, p < .0001). Conclusions In patients who underwent coronary revascularization for multiple vessels including LAD, PCI using SES as compared with CABG was associated with a comparable 5‐year risk for death/MI/stroke as well as for mortality, but with a markedly higher risk for any coronary revascularization.