Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes

Abstract

Background: There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population.

Aim: We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NSTE-ACS.

Methods: A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes.

Results: MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75–2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75–2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46–1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47–1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively).

Conclusions: It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group.