CABG Offers Superior Outcomes Over PCI in High-Risk NSTEMI Patients, reveals research
Researchers have reported better long-term results of coronary artery bypass grafting (CABG) than of percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease, especially in the high-risk subgroups. A recent study was conducted by Elmir O. and colleagues which was published in the European Heart Journal.
The participants were NSTEMI patients treated with multivessel disease from January 2005 and June 2022. Of the 57,097 participants, 42,190 (73.9%) were subjected to PCI, and 14,907 (26.1%) were given CABG. All-cause mortality was evaluated as the first and secondary endpoint and included outcomes such as MI, stroke, new revascularization, and heart failure. Controlling confounding variables used multilevel logistic regression and instrumental variable methods in the analysis.
Patients who underwent PCI were older and had a history of more prior cardiovascular events, whereas CABG patients were more likely to have diabetes, hypertension, left main or three-vessel disease, and reduced ejection fraction.
Key Findings
• Mortality Risk: PCI was associated with a 67% higher risk of death compared to CABG (adjusted odds ratio [aOR] 1.67; 95% confidence interval [CI] 1.54–1.81).
• Myocardial Infarction: Patients who underwent PCI had a 51% increased risk of MI (aOR 1.51; 95% CI 1.41–1.62).
• Stroke: No significant difference in stroke risk was observed between PCI and CABG.
• Repeat Revascularization: Patients who underwent PCI were three times more likely to require repeat revascularization (aOR 3.01; 95% CI 2.57–3.51).
• Heart Failure: CABG was associated with a 15% reduced risk of heart failure (aOR 1.15; 95% CI 1.07–1.25).
• Survival Benefit: CABG conferred longer survival, especially in patients under 70 years of age, or in the presence of left main disease, or with left ventricular dysfunction. This survival benefit was abated in patients with poorer survival probabilities.
Although a superior long-term outcome exists for CABG compared to PCI in patients with multivessel disease and NSTEMI, this comes at the expense of losing the survival advantage in severely ill or high-risk subjects with reduced life expectancy and thus should be used carefully in clinical practice.
Reference:
Omerovic, E., Råmunddal, T., Petursson, P., Angerås, O., Rawshani, A., Jha, S., Skoglund, K., Mohammad, M. A., Persson, J., Alfredsson, J., Hofmann, R., Jernberg, T., Fröbert, O., Jeppsson, A., Hansson, E. C., Dellgren, G., Erlinge, D., & Redfors, B. (2024). Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease: the SWEDEHEART registry. European Heart Journal, ehae700. https://doi.org/10.1093/eurheartj/ehae700
