Outcomes of coronary artery bypass grafting compared with percutaneous coronary intervention in patients with multi-vessel coronary disease.

Abstract

Background: Debate continues regarding the optimal strategy for revascularisation in patients with multi-vessel disease (MVD). Method(s): We compared early and 1-year mortality of1129 consecutive patients undergoing percutaneous coronary intervention (PCI) and 3313 undergoing primary coronary artery bypass grafting (CABG) for MVD between October 2005 and September 2007, enrolled in two Australian registries. Cardiogenic shock, myocardial infarction (MI) < 24 hours, previous CABG, valve surgery or PCI were exclusions. The registries were combined to determine predictors of 1-year mortality by multivariate analysis. Result(s): Age, BMI and ejection fraction were similar between the two groups. The proportion ofwomen (26.4% vs. 19.9%), octogenarians (11.8% vs. 6.9%), renal failure (RF) (4.5% vs. 2.1%),) and MI 1-7 days (41.7% vs. 11.2%) were higher in the PCI group (all p<0.001). The CABG group had a higher incidence of diabetes (33.5% vs. 28.8%, p=0.004), hypertension (77% vs. 68.9%, p<0.001), MI>2 weeks prior (40.5% vs. 24.4%, p<0.001), peripheral vascular disease (12.9% vs. 7.5%, p<0.001), and cerebrovascular disease (11.8% vs. 6.7%, p<0.001). In-hospital mortality was higher in the CABG group (1.3% vs. 0.4%, p=0.003) but 1-year mortality was similar (2.9% vs. 3.3%, p=0.54). Predictors of 1-year mortality were age (OR 1.08, 95% CI 1.061.10), previous CHF (1.86, 1.18-2.88), RF (3.13, 1.58-6.20) and presentation with CHF (<2 weeks; 3.74, 2.33-6.01). Revascularisation strategy (0.97, 0.631.49) and diabetes (1.1, 0.76-1.6) were not predictors of 1-year mortality. Conclusion(s): Early mortality after CABG is higher than PCI amongst patients with multivessel disease, but 1-year mortality is similar. Longer term outcomes are required.