BACKGROUND: The optimal revascularization approach for patients with multivessel coronary artery disease (MVCAD) is controversial. We sought to investigate outcomes in patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction (NSTEMI). METHODS: Adult patients with MVCAD and NSTEMI undergoing either CABG or PCI at a single institution between 2011 and 2018 were included. Multivariable analysis was utilized to determine independent predictors of death, major adverse cardiac and cerebrovascular events (MACCE), and readmissions. A subanalysis examined patients undergoing complete revascularization. RESULTS: A total of 2001 patients were included, of whom 1480 (74.0%) underwent CABG. CABG was associated with a lower risk-adjusted hazard for death (hazard ratio, 0.59, P < .001) and with improved survival at 1 year (92.0 vs 81.8%, P < .001) and 5 years (80.7 vs 63.3%, P < .001). Additionally, freedom from MACCE (P < .001) was greater in the CABG group and cumulative readmission, rates of MI, and rates of repeat revascularization were lower with CABG (each P < .001). Among patients undergoing complete revascularization, overall survival (1 year: 92.7 vs 83.9%, P = .010; 5 years: 81.1 vs 69.4%, P < .001) and freedom from MACCE (1 year: 92.3 vs 75.2%, P < .001; 5 years: 81.7 vs 61.4%, P < .001) remained higher for the CABG group; cumulative incidence of readmission was also decreased in those undergoing CABG (P < .001). CONCLUSIONS: In this real-world analysis of patients with MVCAD presenting with NSTEMI, revascularization with CABG resulted in improved survival with lower rates of MACCE and readmission as compared to PCI, which persisted when accounting for complete revascularization.
BACKGROUND: The optimal revascularization approach for patients with multivessel coronary artery disease (MVCAD) is controversial. We sought to investigate outcomes in patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction (NSTEMI). METHODS: Adult patients with MVCAD and NSTEMI undergoing either CABG or PCI at a single institution between 2011 and 2018 were included. Multivariable analysis was utilized to determine independent predictors of death, major adverse cardiac and cerebrovascular events (MACCE), and readmissions. A subanalysis examined patients undergoing complete revascularization. RESULTS: A total of 2001 patients were included, of whom 1480 (74.0%) underwent CABG. CABG was associated with a lower risk-adjusted hazard for death (hazard ratio, 0.59, P < .001) and with improved survival at 1 year (92.0 vs 81.8%, P < .001) and 5 years (80.7 vs 63.3%, P < .001). Additionally, freedom from MACCE (P < .001) was greater in the CABG group and cumulative readmission, rates of MI, and rates of repeat revascularization were lower with CABG (each P < .001). Among patients undergoing complete revascularization, overall survival (1 year: 92.7 vs 83.9%, P = .010; 5 years: 81.1 vs 69.4%, P < .001) and freedom from MACCE (1 year: 92.3 vs 75.2%, P < .001; 5 years: 81.7 vs 61.4%, P < .001) remained higher for the CABG group; cumulative incidence of readmission was also decreased in those undergoing CABG (P < .001). CONCLUSIONS: In this real-world analysis of patients with MVCAD presenting with NSTEMI, revascularization with CABG resulted in improved survival with lower rates of MACCE and readmission as compared to PCI, which persisted when accounting for complete revascularization.
Authors: Matthew T Roe; Anita Y Chen; Laine Thomas; Tracy Y Wang; Karen P Alexander; Bradley G Hammill; W Brian Gibler; E Magnus Ohman; Eric D Peterson Journal: Am Heart J Date: 2011-10-05 Impact factor: 4.749
Authors: Alfredo E Rodriguez; Julio Baldi; Carlos Fernández Pereira; Jose Navia; Máximo Rodriguez Alemparte; Alejandro Delacasa; Federico Vigo; Daniel Vogel; William O'Neill; Igor F Palacios Journal: J Am Coll Cardiol Date: 2005-08-16 Impact factor: 24.094
Authors: Stephan D Fihn; James C Blankenship; Karen P Alexander; John A Bittl; John G Byrne; Barbara J Fletcher; Gregg C Fonarow; Richard A Lange; Glenn N Levine; Thomas M Maddox; Srihari S Naidu; E Magnus Ohman; Peter K Smith Journal: J Am Coll Cardiol Date: 2014-07-28 Impact factor: 24.094
Authors: Ezra A Amsterdam; Nanette K Wenger; Ralph G Brindis; Donald E Casey; Theodore G Ganiats; David R Holmes; Allan S Jaffe; Hani Jneid; Rosemary F Kelly; Michael C Kontos; Glenn N Levine; Philip R Liebson; Debabrata Mukherjee; Eric D Peterson; Marc S Sabatine; Richard W Smalling; Susan J Zieman Journal: Circulation Date: 2014-09-23 Impact factor: 29.690
Authors: Elizabeth A Magnuson; Michael E Farkouh; Valentin Fuster; Kaijun Wang; Katherine Vilain; Haiyan Li; Jaime Appelwick; Victoria Muratov; Lynn A Sleeper; Robin Boineau; Mouin Abdallah; David J Cohen Journal: Circulation Date: 2012-12-31 Impact factor: 29.690
Authors: Piroze M Davierwala; Alexander Verevkin; Sergey Leontyev; Martin Misfeld; Michael A Borger; Friedrich W Mohr Journal: Circulation Date: 2015-08-25 Impact factor: 29.690