Composite outcomes in coronary bypass surgery versus percutaneous intervention.


Journal Article

BACKGROUND: Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation. METHODS: CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors. RESULTS: There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83). CONCLUSIONS: The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.

Full Text

Duke Authors

Cited Authors

  • Edwards, FH; Shahian, DM; Grau-Sepulveda, MV; Grover, FL; Mayer, JE; O'Brien, SM; DeLong, E; Peterson, ED; McKay, C; Shaw, RE; Garratt, KN; Dangas, GD; Messenger, J; Klein, LW; Popma, JJ; Weintraub, WS

Published Date

  • June 2014

Published In

Volume / Issue

  • 97 / 6

Start / End Page

  • 1983 - 1988

PubMed ID

  • 24775805

Pubmed Central ID

  • 24775805

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2014.01.087


  • eng

Conference Location

  • Netherlands