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Composite outcomes in coronary bypass surgery versus percutaneous intervention.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2014 Jun; Vol. 97 (6), pp. 1983-8; discussion 1988-90. Date of Electronic Publication: 2014 Apr 26. - Publication Year :
- 2014
-
Abstract
- Background: Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation.<br />Methods: CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors.<br />Results: There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83).<br />Conclusions: The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.<br /> (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 97
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24775805
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2014.01.087