Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3)

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There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.

Section snippets

Methods

The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry Cohort-3 is a physician-initiated, non-company-sponsored, multicenter registry enrolling consecutive patients who underwent first coronary revascularization with PCI or isolated CABG without combined noncoronary surgery among 22 Japanese centers between January 2011 and December 2013 (Supplementary Appendix). Both PCI and CABG were available in 16 centers, while there was no cardiovascular

Results

The current study population consisted of 1747 patients (69%) who underwent PCI, and 778 patients (31%) who underwent CABG (Figure 1). Among 2248 patients who were enrolled from those centers with both PCI and CABG facilities, there were 1470 (65%) patients treated with PCI, and 778 (35%) treated with CABG.

Patients in the PCI group was significantly older and more often had severe frailty and malignancy, but not active malignancy, than those in the CABG group, whereas patients in the CABG group

Discussion

The main findings of this study comparing PCI with CABG in patients with 3VD in the new-generation DES era were as follows; (1) In the present study population reflecting real-world clinical practice in Japan between 2011 and 2013, PCI was the preferred modality of coronary revascularization used in almost two-thirds of patients with 3VD; (2) PCI compared with CABG was associated with significantly higher risk for all-cause death, which was mainly driven by the excess risk for

Author Credit Statement

Yukiko Matsumura-Nakano: Methodology, Formal analysis, Investigation, Data curation, Writing-Original Draft; Hiroki Shiomi: Methodology, Investigation, Data curation, Writing-Review and Editing, Supervision, Project administration; Takeshi Morimoto: Methodology, Formal analysis, Writing-Review and Editing, Supervision; Kyohei Yamaji: Investigation, Resources, Writing-Review and Editing; Natsuhiko Ehara: Investigation, Resources; Hiroki Sakamoto: Investigation, Resources; Yasuaki Takeji:

Disclosures

Dr. Shiomi reports honoraria from Abbott Vascular, and Boston Scientific. Dr. Morimoto reports honoraria from Bayer and Kowa, and expert witness from Boston Scientific and Sanofi. Dr. Ehara reports honoraria from Abbott Vascular, Bayer, Boston Scientific, Medtronic, and Terumo. Dr. Furukawa reports honoraria from Bayer, Kowa, and Sanofi. Dr. Nakagawa reports research grant from Abbott Vascular and Boston Scientific, and honoraria from Abbott Vascular, Bayer, and Boston Scientific. Dr. Kimura

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study.

Acknowledgment

We thank the clinical research coordinators of the Research Institute for Production Development.

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    Sources of funding: This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan).

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