Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3.
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Watanabe Hiroki, Yamamoto Ko, Shiomi Hiroki, Morimoto Takeshi, Kato Eri, Matsumura Yukiko, Nakatsuma Kenji, Takeji Yasuaki, Yaku Hidenori, Yamamoto Erika, Yamashita Yugo, Yoshikawa Yusuke, Fuki Masayuki, Yamaji Kyohei, Ehara Natsuhiko, Sakamoto Hiroki, Imada Kazuaki, Tada Takeshi, Taniguchi Ryoji, Nishikawa Ryusuke, Tada Tomohisa, Uegaito Takashi, Ogawa Tatsuya, Yamada Miho, Takeda Teruki, Eizawa Hiroshi, Tamura Nobushige, Tambara Keiichi, Suwa Satoru, Shirotani Manabu, Tamura Toshihiro, Inoko Moriaki, Nishizawa Junichiro, Natsuaki Masahiro, Sakai Hiroshi, Yamamoto Takashi, Kanemitsu Naoki, Ohno Nobuhisa, Ishii Katsuhisa, Marui Akira, Tsuneyoshi Hiroshi, Terai Yasuhiko, Nakayama Shogo, Yamazaki Kazuhiro, Takahashi Mamoru, Tamura Takashi, Esaki Jiro, Miki Shinji, Onodera Tomoya, Mabuchi Hiroshi, Furukawa Yutaka, Tanaka Masaru, Komiya Tatsuhiko, Soga Yoshiharu, Hanyu Michiya, Ando Kenji, Kadota Kazushige, Minatoya Kenji, Nakagawa Yoshihisa, Kimura Takeshi, On behalf the CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators
Аннотация
METHODS AND RESULTS: The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04-1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96-1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79-1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05-2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06-3.43, P<0.0001).
CONCLUSIONS: In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.