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) - 22/03/21
, Takeshi Morimoto, MD b, Kyohei Yamaji, MD c, Natsuhiko Ehara, MD d, Hiroki Sakamoto, MD e, Yasuaki Takeji, MD a, Yusuke Yoshikawa, MD a, Ko Yamamoto, MD a, Kazuaki Imada, MD c, Takeshi Tada, MD f, Ryoji Taniguchi, MD g, Ryusuke Nishikawa, MD e, Tomohisa Tada, MD e, Takashi Uegaito, MD h, Tatsuya Ogawa, MD i, Miho Yamada, MD j, Teruki Takeda, MD k, Hiroshi Eizawa, MD l, Nobushige Tamura, MD m, Keiichi Tambara, MD n, Satoru Suwa, MD o, Manabu Shirotani, MD p, Toshihiro Tamura, MD q, Moriaki Inoko, MD r, Junichiro Nishizawa, MD s, Masahiro Natsuaki, MD t, Hiroshi Sakai, MD u, Takashi Yamamoto, MD u, Naoki Kanemitsu, MD v, Nobuhisa Ohno, MD w, Katsuhisa Ishii, MD x, Akira Marui, MD y, Hiroshi Tsuneyoshi, MD z, Yasuhiko Terai, MD aa, Shogo Nakayama, MD bb, Kazuhiro Yamazaki, MD cc, Mamoru Takahashi, MD dd, Takashi Tamura, MD ee, Jiro Esaki, MD ff, Shinji Miki, MD gg, Tomoya Onodera, MD hh, Hiroshi Mabuchi, MD k, Yutaka Furukawa, MD d, Masaru Tanaka, MD ii, Tatsuhiko Komiya, MD jj, Yoshiharu Soga, MD y, Michiya Hanyu, MD kk, Kenji Ando, MD c, Kazushige Kadota, MD f, Kenji Minatoya, MD cc, Yoshihisa Nakagawa, MD u, Takeshi Kimura, MD aOn behalf the CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators
Résumé |
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.
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| Sources of funding: This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). |
Vol 145
P. 25-36 - avril 2021 Retour au numéro
Article précédent
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- Ko Yamamoto, Masahiro Natsuaki, Takeshi Morimoto, Hiroki Shiomi, Yasuaki Takeji, Kazushige Kadota, Kazuaki Imada, Mamoru Toyofuku, Naoki Kanemitsu, Eiji Shinoda, Satoru Suwa, Atsushi Iwakura, Toshihiro Tamura, Yoshiharu Soga, Tsukasa Inada, Mitsuo Matsuda, Tadaaki Koyama, Takeshi Aoyama, Eri Kato, Yukihito Sato, Yutaka Furukawa, Kenji Ando, Fumio Yamazaki, Tatsuhiko Komiya, Kenji Minatoya, Yoshihisa Nakagawa, Takeshi Kimura
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