| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 24
| Issue : 3 | Page : 141-147 |
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Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center
Kerrick Hesse, Mohaned Egred, Azfar Zaman, Mohammad Alkhalil, Mohamed Farag
Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
Correspondence Address:
Mohamed Farag
Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, NE7 7DN
UK
Mohammad Alkhalil
Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, NE7 7DN
UK
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/heartviews.heartviews_116_22
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Background: Clinical equipoise between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) in the treatment of complex coronary artery disease (CAD), including unprotected left main coronary artery (LMCA) and/or three-vessel disease (3VD), remains debatable.
Methods: A retrospective analysis of an unselected cohort undergoing contemporary PCI versus CABG at a large center in 2015. Patients who received nonemergent treatment of unprotected LMCA and/or 3VD were included. The primary study endpoint was all-cause mortality at 5 years. Secondary endpoints included a composite of all-cause mortality, spontaneous myocardial infarction (MI), or ischemia-driven repeat revascularization at 30 days and 1 year.
Results: Four hundred and thirty patients met the inclusion criteria, 225 had PCI, and 205 had CABG. PCI patients were older with frequent LMCA involvement and higher EuroSCORE yet they had a fourfold shorter in-hospital stay compared to CABG patients. At 5 years, there was no significant difference in the primary endpoint between CABG and PCI (adjusted Hazard ratios 0.68, 95% confidence interval: 0.38–1.22, P = 0.19). Likewise, there was no significant difference in the incidence of the secondary composite endpoint or its components at 30 days or 1 year. A propensity score-matched analysis in 220 patients revealed similar outcomes.
Conclusions: In real-world long-term contemporary data, survival after PCI was comparable to CABG at 5 years in patients with unprotected LMCA and/or 3VD. At 1 year, the incidence of spontaneous MI and ischemia-driven repeat revascularization did not differ between the two cohorts. The mode of revascularization in these complex patients should be guided by the heart team.
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