PCI vs. CABG in

Original title: Comparison of 30-Day and 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Bypass Grafting in Patients Aged ≤50 Years.  Reference: Fausto Biancari, et al. Am J Cardiology Article in Press.

Coronary artery bypass grafting (CABG) is associated with better evolution than percutaneous coronary intervention (PCI), mainly due to left main and multiple vessels re interventions. In ≤50 year old patients, results have not been thoroughly analyzed.

This retrospective analysis included 1617 patients receiving PCI and 592 receiving CABG for multiple vessels disease or left main lesions. Diabetes, renal failure, peripheral vascular disease, severe left main lesion, previous intervention and severe ventricular dysfunction occurred more often in the CABG group.

After propensity score matching, given the different baseline characteristics, 235 patients remained for final analysis. Immediate evolution, late mortality and freedom from cerebrovascular events at 5 years were similar in both groups. 

On the other hand, PCI patients presented lower freedom form revascularization and myocardial infarction. Among diabetics, global mortality was also similar in PCI and CABG groups but with greater chances of infarction, revascularization and stroke in the PCI group. 

STEMI patients receiving PCI presented a higher survival rate at 5 years, driven by its lower 30 day mortality rate (6% vs 1.5%; p=0.017). Freedom from combined events in this last group was similar. PCI was associated with repeat revascularization.

Conclusion

≤50 year patients have excellent immediate evolution with both PCI and CABG. At 5 years, PCI was associated with a significantly higher rate of infarction or repeat revascularization. 

Commentary

This analysis shows that evolution at 5 years with PCI or CABG is similar in terms or mortality. PCI is associated with higher rates of repeat revascularization and non-fatal AMI, as the large randomized studies show. In patients presenting with STEMI, PCI was superior to CABG in terms of mortality, which offers an advantage.

Carlos Fava

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