Abstract 14238: A Real-World Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass in Patients With Chronic Total Occlusion

Abstract

Introduction: There is a paucity of data comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic total occlusion (CTO) of the coronary arteries. Methods: The National Inpatient Sample (NIS) database was queried to identify all CTO related hospitalizations from 2002-2018. Patients undergoing PCI were compared with those having CABG for CTO using Cochran-Mantel-Haenszel statistics to determine unadjusted odds ratios (OR). A propensity matched analysis (PSM) was used to determine adjusted OR for major in-hospital outcomes. Results: A total of 404,563 patients with CTO were included in the analysis. Of these, 20,841 (5.6%) patients underwent CABG whereas 383,722 (94.8%) underwent PCI. Patients in the PCI group had a higher percentage of chronic obstructive pulmonary disease, diabetes, coagulopathy, obesity and renal failure. On an unadjusted analysis, the primary outcome of in-hospital mortality was comparable between the two groups. The odds of stroke, acute kidney injury, sepsis, major bleeding and need for IABP were higher with CABG, whereas the odds of cardiopulmonary arrest and coronary artery dissection were higher with PCI. On a propensity adjusted analysis, PCI was associated with a higher mortality and comparable rate of major bleeding and sepsis compared to CABG (Table). CABG, however, had a higher hospitalization cost ($ 156113.03 vs. $ 103078.48, p=<0.0001), and a mean length of stay (8.93 vs. 4.82 days, p=<0.0001) as compared to PCI. Conclusions: Our findings show that CABG has a lower inpatient mortality for CTO as compared to PCI, however it is associated with increased risk of complications, higher cost and increased length of hospitalization, highlighting the need for randomized data on the subject.