Author + information
- Daniel Thuijs1,
- Robert Habib2,
- Gregg Stone3,
- Patrick Serruys4,
- Joseph Sabik5 and
- A. Pieter Kappetein1
- 1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 2The Society of Thoracic Surgeons, Chicago, Illinois, United States
- 3Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 4Imperial College, London, United Kingdom
- 5Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
Whether STS risk scores can accurately predict outcomes in patients with left main (LM) coronary artery disease undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is unknown.
We compared the observed 30-day mortality and stroke rates to those expected from the corresponding STS risk models for patients undergoing LM revascularization by PCI with everolimus-eluting stents (n=948) and CABG (n=957). Comparisons were made by observed-to-expected ratios (O/E) and for quintile subgroups (Q1=low risk, Q5=high risk) within each treatment group.
Randomized EXCEL trial groups had similar expected 30-day STS risk scores: mortality [mean; median (IQR): PCI - 0.91%; 0.62% (0.37%-1.06%) vs CABG - 0.86%; 0.62% (0.38%-1.01%); p=0.69], and stroke [0.77%; 0.59% (0.41%-0.91%) vs [0.76%; 0.62% (0.40%-0.95%)]; p=0.42]. Observed 30-day mortality rates were similar for CABG and PCI [10 (1.05%) vs 9 (0.95%); O/E: 1.21 vs 1.04, p=0.83] as were 30-day stroke rates [12 (1.25%)vs 6 (0.63%); O/E= 1.64 vs 0.82; p=0.16]. Subgroup analysis of 30-day mortality O/E showed that for patients with low STS mortality risk, observed mortality might be greater than expected in case of PCI and lower in case of CABG[Fig, top]. Stroke risk tended to be lower for PCI across most STS risk quintiles[Fig, bottom].
In the EXCEL trial, STS CABG risk models predicted aggregate 30-day CABG and PCI mortality reasonably well, although CABG appeared safer in the lowest-risk patients while PCI appeared safer for higher-risk patients. Stroke risk tended to be less with PCI than for CABG.
CORONARY: Cardiac Surgery