Author + information
- Kuan-chun Chen and
- Wei-Hsian Yin
The current guidelines on coronary revascularization for patients with left main or multi-vessel coronary artery disease (LM/MVCAD) recommended that a surgical option should be selected for those patients with low surgical risk (EuroSCORE < 5), and high SYNTAX score ≥ 32. Whether total revascularization with stage PCI provide similar efficacy as coronary artery bypass grafting (CABG) is less been studied.
We retrospectively analyzed all patients (n=280) with LM/MVCAD, low surgical risk, and high SYNTAX score referred to either CABG or PCI at our institution during 2010-2012. We compared 3 different strategies and outcomes at 3-year follow-up.
No significant different of baseline characteristics between culprit PCI (n= 128), stage PCI (n=49) and CABG (n=103) groups. No difference of primary endpoints (death, recurrent myocardial infarction, stroke) between 3 groups (p= 0.14). However, CABG group had significantly less secondary composite endpoints (primary plus target vessel revascularization (TVR), p= 0.0003). However, which was insignificant for non-DM subgroup. As regard to left main disease patients, CABG and stage PCI had significant better event free for primary endpoints compare with culprit PCI group (93%, 90.5% vs. 84.4%, p= 0.0275).
For LM/MVCAD patients with low surgical risk. CABG has less future TVR rate but had similar primary composite endpoints of death, MI and stroke. However, for left main disease patients, stage PCI may be an alternative of CABG regards to primary endpoints.