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

AIMS: There 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 RESULTS: The 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). CONCLUSIONS: In 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

Baseline characteristics, medications, angiographic and procedural characteristics during the index hospitalization in the propensity score-matched cohort.

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Subgroup analyses for the primary outcome measure (death/MI/stroke).

Subgroup analyses for the primary outcome measure (death/MI/stroke).</p

Kaplan-Meier event curves for clinical outcomes in patients with two-vessel or three-vessel disease including proximal LAD.

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Fig 2 -

Crude kaplan-meier curves for the cumulative incidence of (A) all-cause death/MI/stroke, (B) all-cause death, (C) any coronary revascularization, and (D) all-cause death/MI/stroke/any coronary revascularization. PCI = percutaneous coronary intervention; CABG = coronary artery bypass grafting; MI = myocardial infarction.</p

Clinical outcomes in the propensity score-matched cohort.

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Landmark analysis at 1 year and at 2 years for any coronary revascularization.

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Study flowchart.

BMS = bare-metal stent; CREDO-Kyoto PCI/CABG Registry Cohort-3 = Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG registry; CABG = coronary artery bypass grafting; G-1 DES = first-generation drug-eluting stent; LAD = left anterior descending coronary artery; LMCA = left main coronary artery; PCI = percutaneous coronary intervention; G-2 DES = second-generation drug-eluting stent.</p