PCI Versus CABG in Multivessel CAD: Long-term Outcomes

By Patrick Zakka, MD - March 15, 2023

In a recent article, published in Circulation, investigators compared extended outcomes of patients with multivessel coronary artery disease (CAD) who underwent either percutaneous coronary intervention (PCI) with everolimus-eluting stents or coronary artery bypass graft (CABG) in the BEST trial.

According to the report, there were no significant differences between PCI and CABG in rates of major adverse cardiac events, safety composite events, and any-cause mortality during extended follow-up.

However, authors did note that the PCI group had more frequent spontaneous myocardial infarction (7.1% vs 3.8%; hazard ratio [HR], 1.86; 95% CI, 1.06-3.27; P=.031) and any repeat revascularization (22.6% vs 12.7%; HR, 1.92; 95% CI, 1.58-2.32; P<.001) compared with the CABG group.

PCI and CABG Show Similar Outcomes in Multivessel CAD

Between July 2008 and September 2013, the BEST trial enrolled 880 patients out of a planned 1776 before ending the trial early due to slow enrollment. The final analyses included 438 participants in the PCI group and 442 in the CABG group, and the primary end point was a composite of any-cause mortality, myocardial infarction, or target vessel revascularization events.

Over a median follow-up of 11.8 years (interquartile range [IQR], 10.6-12.5 years), 151 (34.5%) patients in the PCI group and 134 (30.3%) patients in the CABG group had primary end point events (HR, 1.18; 95% CI, 0.88-1.56; P=.26).

Researchers found no significant differences between the groups in a safety analysis that included death, myocardial infarction, or stroke outcomes (28.8% vs 27.1%; HR, 1.07; 95% CI, 0.75-1.53; P=.70). The rate of any-cause mortality itself was 20.5% in the PCI group and 19.9% in the CABG group (HR, 1.04; 95% CI, 0.65-1.67; P=.86).

“In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up,” the authors summarized.

Related: Adjunct Bone Marrow Injection in CABG Procedures

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