Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3.

Hiroki Watanabe,Yoshihisa Nakagawa,Masayuki Fuki,Yutaka Furukawa,Masahiro Natsuaki,Nobuhisa Ohno,Yugo Yamashita,Akira Marui,Tomoya Onodera,Kazushige Kadota,Takashi Yamamoto,Ryusuke Nishikawa,Junichiro Nishizawa,Toshihiro Tamura,Ryoji Taniguchi,Nobushige Tamura,Hiroshi Sakai,Hiroki Shiomi,Takeshi Tada,Jiro Esaki,Yukiko Matsumura,Takeshi Morimoto,Kenji Minatoya,Tatsuhiko Komiya,Masaru Tanaka,Hidenori Yaku,Kenji Nakatsuma,Kazuaki Imada,Mamoru Takahashi,Naoki Kanemitsu,Hiroki Sakamoto,Keiichi Tambara,Satoru Suwa,Manabu Shirotani,Yusuke Yoshikawa,Takashi Uegaito,Hiroshi Tsuneyoshi,Kenji Ando,Michiya Hanyu,Natsuhiko Ehara,Ko Yamamoto,Eri Kato,Moriaki Inoko,Shogo Nakayama,Yoshiharu Soga,Yasuhiko Terai,Kazuhiro Yamazaki,Yasuaki Takeji,Kyohei Yamaji,Tatsuya Ogawa,Takashi Tamura,Hiroshi Eizawa,Katsuhisa Ishii,Takeshi Takeda ,Hiroshi Mikami ,M Yamada ,Miki Sato ,Etsuhide Yamamoto

doi:10.1371/journal.pone.0267906

Abstract

AimsThere is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease.Methods and resultsThe CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04–1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96–1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79–1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05–2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06–3.43, P<0.0001).ConclusionsIn this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.

Full Text