Open Heart Surgery Beats Stents for Multivessel Disease
Findings reinforce need for team approach to treatment decisions for heart conditions
FRIDAY, May 17, 2019 (HealthDay News) -- Coronary artery bypass graft (CABG) surgery may be a better treatment option than percutaneous coronary intervention (PCI) for most patients with more than one blocked heart artery, according to a study published online May 1 in the Annals of Thoracic Surgery.
Suresh R. Mulukutla, M.D., from the University of Pittsburgh Medical Center, and colleagues used data from the National Cardiovascular Data Registry and The Society of Thoracic Surgeons Adult Cardiac Surgery Database to identify patients with multivessel coronary artery disease (MVCAD) who underwent CABG or PCI between 2010 and 2018. The analysis included 844 propensity-matched patients in each group.
The researchers found that estimated one-year mortality was 11.5 percent in the PCI group and 7.2 percent in the CABG group, with an overall hazard ratio (HR) for mortality of PCI versus CABG of 1.64. For readmission, the overall HR was 1.42 for PCI versus CABG, while for repeat revascularization, the overall HR for PCI versus CABG was 4.06. CABG was favored for major adverse cardiovascular events and individual outcomes of mortality, readmission, and repeat revascularization across virtually all major clinical subgroups.
"Future studies are needed reflecting routine practice to assess how best to approach shared decision making and informed consent when it comes to revascularization decisions in any patient with MVCAD," the authors write.