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Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation.
Circ J. 2018 03 23; 82(4):1092-1100.CJ

Abstract

BACKGROUND

The long-term outcome of percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG), particularly for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), remains controversial.Methods and Results:We retrospectively analyzed 2,827 patients (stable coronary artery disease [SCAD], n=1,601; NSTE-ACS, n=1,226) who underwent either PCI (n=1,732) or CABG (n=1,095). The 8-year composite of cardiac death and myocardial infarction (MI) was compared between PCI and CABG before and after propensity matching. For patients with NSTE-ACS, PCI was performed more frequently for those with higher Thrombolysis in Myocardial Infarction risk score and 3-vessel disease, and PCI led to significantly higher 8-year composite of cardiac death and MI than CABG (14.1% vs. 5.9%, hazard ratio [HR]=2.22, 95% confidence interval [CI]=1.37-3.58, P=0.001). There was a significant interaction between clinical presentation and revascularization strategy (P-interaction=0.001). However, after matching, the benefit of CABG vs. PCI was attenuated in patients with NSTE-ACS, whereas it was pronounced in those with SCAD. Interactions between clinical presentation and revascularization strategy were not observed (P-interaction=0.574).

CONCLUSIONS

Although the determinants of PCI vs. CABG in real-world clinical practice differ according to the clinical presentation, a significant interaction between clinical presentation and revascularization strategy was not noted for long-term outcomes. The revascularization strategy for patients with NSTE-ACS can be based on the criteria applied to patients with SCAD.

Authors+Show Affiliations

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital.Division of Cardiology, Department of Internal Medicine, Myongji Hospital.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29434090

Citation

Hong, Sung-Jin, et al. "Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions Vs. Surgery for Multivessel Disease According to Clinical Presentation." Circulation Journal : Official Journal of the Japanese Circulation Society, vol. 82, no. 4, 2018, pp. 1092-1100.
Hong SJ, Kim BK, Shin S, et al. Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation. Circ J. 2018;82(4):1092-1100.
Hong, S. J., Kim, B. K., Shin, S., Suh, Y., Kim, S., Ahn, C. M., Kim, J. S., Ko, Y. G., Choi, D., Hong, M. K., & Jang, Y. (2018). Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation. Circulation Journal : Official Journal of the Japanese Circulation Society, 82(4), 1092-1100. https://doi.org/10.1253/circj.CJ-17-1173
Hong SJ, et al. Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions Vs. Surgery for Multivessel Disease According to Clinical Presentation. Circ J. 2018 03 23;82(4):1092-1100. PubMed PMID: 29434090.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation. AU - Hong,Sung-Jin, AU - Kim,Byeong-Keuk, AU - Shin,Sanghoon, AU - Suh,Yongsung, AU - Kim,Seunghwan, AU - Ahn,Chul-Min, AU - Kim,Jung-Sun, AU - Ko,Young-Guk, AU - Choi,Donghoon, AU - Hong,Myeong-Ki, AU - Jang,Yangsoo, Y1 - 2018/02/09/ PY - 2018/2/13/pubmed PY - 2019/8/14/medline PY - 2018/2/14/entrez KW - Coronary artery bypass graft KW - Percutaneous coronary intervention SP - 1092 EP - 1100 JF - Circulation journal : official journal of the Japanese Circulation Society JO - Circ. J. VL - 82 IS - 4 N2 - BACKGROUND: The long-term outcome of percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG), particularly for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), remains controversial.Methods and Results:We retrospectively analyzed 2,827 patients (stable coronary artery disease [SCAD], n=1,601; NSTE-ACS, n=1,226) who underwent either PCI (n=1,732) or CABG (n=1,095). The 8-year composite of cardiac death and myocardial infarction (MI) was compared between PCI and CABG before and after propensity matching. For patients with NSTE-ACS, PCI was performed more frequently for those with higher Thrombolysis in Myocardial Infarction risk score and 3-vessel disease, and PCI led to significantly higher 8-year composite of cardiac death and MI than CABG (14.1% vs. 5.9%, hazard ratio [HR]=2.22, 95% confidence interval [CI]=1.37-3.58, P=0.001). There was a significant interaction between clinical presentation and revascularization strategy (P-interaction=0.001). However, after matching, the benefit of CABG vs. PCI was attenuated in patients with NSTE-ACS, whereas it was pronounced in those with SCAD. Interactions between clinical presentation and revascularization strategy were not observed (P-interaction=0.574). CONCLUSIONS: Although the determinants of PCI vs. CABG in real-world clinical practice differ according to the clinical presentation, a significant interaction between clinical presentation and revascularization strategy was not noted for long-term outcomes. The revascularization strategy for patients with NSTE-ACS can be based on the criteria applied to patients with SCAD. SN - 1347-4820 UR - https://www.unboundmedicine.com/medline/citation/29434090/Determinants_and_Long_Term_Outcomes_of_Percutaneous_Coronary_Interventions_vs__Surgery_for_Multivessel_Disease_According_to_Clinical_Presentation_ L2 - https://dx.doi.org/10.1253/circj.CJ-17-1173 DB - PRIME DP - Unbound Medicine ER -