Long-term mortality in patients with coronary heart disease after surgical revascularization and percutaneous coronary intervention

Abstract

Introduction. Numerous randomized trials have compared success of surgical myocardial revascularization (CABG) and percutaneous coronary intervention (PCI) in the treatment of coronary artery disease. Large clinical registries published that compared to percutaneous intervention, coronary surgery is still associated with better long-term survival. Objective. The aim was to examine the overall and cardiac mortality after coronary artery bypass graft and percutaneous coronary intervention and examine the validity of non-randomized studies in the evaluation of their successes. Method. The study included 186 patients with coronary artery disease (57.2 ± 7.5 years), 93 (50%) with CABG (57.9 ± 9.0 years) and 93 (50%) with PCI (56.3 ± 5.0) (p>0.05). From the total number of patients was isolated a subgroup of 109 patients who had intervention more than five years ago, 62 (56.9%) of them with CABG and 47 (43.1%) with PCI. We assessed the overall and cardiac mortality in patients with CABG and PCI. Start of the follow-up was the date of myocardial revascularization. Patients with CABG were followed 84.4 ± 64.4 months, and those with PCI 65.7 ± 49.4 months (p<0.01). Results In the group of patients treated with CABG, followed for 7 years in average, died 28 (30.1%), with an average annual mortality of 4.2%. Cardiac death was diagnosed in 26 (27.9%) patients, and annual mortality was 3.9%. In the group of patients treated with PCI, followed in average of 5.5 years, died 7 (7.5%), with an average annual mortality rate of 1.3%. Cardiac death was diagnosed in 6 (6.4%) patients with an annual mortality rate 1.2%. At the end of the first year, the mortality rate of patients treated with CABG and PCI was 5.3% and 1.0%, in the third year 9.6% and 4.3% and in the fifth year 13.9% and 4.3% respectively. In the subgroup of patients who have survived at least five years from date of the intervention, in next five years, died 11.3% of patients with CABG and 2.1% with PCI (p <0.01). Mortality of patients with three vessel disease treated with CABG, was 32.8%, during 5.7 years of follow-up and the mortality of the patients with PCI was 11.7% during 6.7 years of follow-up (p <0.05). The mortality of patients with multivessel disease, treated with CABG and PCI was 27.9% and 12.9% respectively (p <0.05). Conclusion. Patients treated by PCI compared to patients treated by CABG exhibited lower average annual cardiac mortality, lower mortality in first five years from the time of revascularization, and significantly lower mortality in three vessel and multivessel disease. The low mortality rate of patients treated by percutaneous coronary intervention with stent implantation indicates favorable impact of PCI treatment on long term survival of patients with coronary artery disease. A small number of patients and significant differences in clinical, angiographic and echocardiography characteristics of patients are limiting factor valid and relevant comparison of success between CABG and PCI revascularization therapy.