Author + information
- Received December 7, 2016
- Revision received April 13, 2017
- Accepted April 17, 2017
- Published online July 17, 2017.
- Jung-Min Ahn, MDa,
- Duk-Woo Park, MDa,
- Cheol Whan Lee, MDa,∗ (, )
- Mineok Chang, MDa,
- Rafael Cavalcante, MDb,
- Yohei Sotomi, MDc,
- Yoshinobu Onuma, MDb,
- Erhan Tenekecioglu, MDb,
- Minkyu Han, PhDd,
- Pil Hyung Lee, MDa,
- Soo-Jin Kang, MDa,
- Seung-Whan Lee, MDa,
- Young-Hak Kim, MDa,
- Seong-Wook Park, MD, PhDa,
- Patrick W. Serruys, MD, PhDb,e and
- Seung-Jung Park, MD, PhDa
- aDivision of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea
- bErasmus University Medical Center, Amsterdam, the Netherlands
- cAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- dDivision of Biostatistics, Asan Medical Center, University of Ulsan, Seoul, Korea
- eInternational Center for Circulatory Health, Imperial College of London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Cheol Whan Lee, Heart Institute, Asan Medical Center, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea.
Objectives The aim of this study was to compare long-term survival between patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG) and those undergoing percutaneous coronary intervention (PCI) achieving complete revascularization (CR) or incomplete revascularization.
Background The importance of CR in decision making regarding revascularization strategy in patients with severe coronary artery disease is unknown.
Methods Data were pooled from the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trials. The primary outcome was death from any cause and was compared in an as-treated analysis.
Results The rate of CR was 61.7% (57.2% with PCI and 66.8% with CABG). During a median 4.9-year follow-up period (interquartile range: 4.5 to 5.0 years), compared with patients undergoing CABG with CR, those undergoing PCI with incomplete revascularization had a higher risk for death from any cause (adjusted hazard ratio [aHR]: 1.43; 95% confidence interval [CI]: 1.03 to 2.00; p = 0.036) and the composite of death, myocardial infarction, and stroke (aHR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003). However, there was no significant difference between patients undergoing CABG with CR and those undergoing PCI with CR regarding the risk for death from any cause (aHR: 1.16; 95% CI: 0.83 to 1.63; p = 0.39) and the composite of death, myocardial infarction, and stroke (aHR: 1.14; 95% CI: 0.87 to 1.48; p = 0.35). Subgroup analysis of multivessel coronary disease, high SYNTAX score (>32), and diabetes showed consistent findings.
Conclusions For the treatment of left main or multivessel coronary artery disease, PCI resulting in CR was associated with a similar long-term survival rate to CABG resulting in CR. Therefore, the ability to achieve CR should enter into the decision algorithm for choice of revascularization strategy.
This study was supported by funds from the CardioVascular Research Foundation (Seoul, Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ahn and D.-W. Park contributed equally to this work.
- Received December 7, 2016.
- Revision received April 13, 2017.
- Accepted April 17, 2017.