Author + information
- 1National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, Beijing, China
- 2Fuwai Hospital, CAMS&PUMC, Beijing, Beijing, China
- 3China Medical Association, Bejing, Hebei, China
- 4Fuwai Hospital, Beijing, Beijing, China
- 5Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China, Beijing, Beijing, China
- 6Fuwai Hospital, Beijing, China
The optimal treatment strategy for triple–vessel coronary disease (TVD) remains a critical and uncertain issue. This study aimed to determine the long-term outcome of patients undergoing either percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medication therapy (MT) alone in the real world of China.
From 2004 to 2011, we recruited 8,943 patients angiographically confirmed ≥50% stenosis in all three major epicardial coronary arteries in a median 6.6-year follow-up. The primary end point was all-cause mortality. The secondary end points were cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction (MI), stroke or repeat revascularization and the individual components.
PCI, CABG and MT alone were performed in 3,825 (42.8%), 2,697 (30.2%) and 2,421 (27.1%) patients respectively. The unadjusted all-cause mortality was significantly different among groups with the highest rate 26.5% in MT alone versus PCI 11.5% versus CABG 10.6%, p <0.001. After baseline characteristic adjustment, MT alone had the worst outcomes comparing with PCI and CABG. CABG was associated with lower risks of all-cause mortality (HR: 0.81; 95%CI: 0.70-0.94; p <0.001) and MACCE (HR: 0.65; 95%CI: 0.59-0.72; p <0.001), but higher risk of stroke versus PCI.
|PCI (n=3,825)||CABG (n=2,697)||MT alone (n=2,421)||p value|
|All-cause death||438 (11.5)||285 (10.6)||642 (26.5)||<0.001|
|Cardiac death||198 (5.2)||97 (3.6)||394 (16.3)||<0.001|
|MACCE*||1,211 (31.7)||622 (23.1)||997 (41.2)||<0.001|
|Death/MI/Stroke||925 (24.2)||564 (20.9)||865 (35.7)||<0.001|
|MI||318 (8.3)||67 (2.5)||130 (5.4)||<0.001|
|Stroke||237 (6.2)||252 (9.3)||153 (6.3)||<0.001|
|Repeat revascularization||472 (12.3)||84 (3.1)||204 (8.4)||<0.001|
For TVD patients, CABG was associated with a lower risk of death, MI or repeat revascularization, but a higher risk of stroke versus PCI in long-term follow-up. Patients that received MT alone have the worst long-term clinical outcomes.
CORONARY: PCI Outcomes