Advertisement

Comparison of Five-Year Outcome of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Triple-Vessel Coronary Artery Disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2)

      Studies evaluating long-term (≥5 years) outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD) are still limited. We identified 2,978 patients with TVD (PCI: n = 1,824, CABG: n = 1,154) of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2. The primary outcome measure in the present analysis was a composite of death, myocardial infarction (MI), and stroke. Median follow-up duration for the surviving patients was 1,973 days (interquartile range 1,700 to 2,244). The cumulative 5-year incidence of death/MI/stroke was significantly higher in the PCI group than in the CABG group (28.2% vs 24.0%, log-rank p = 0.006). After adjusting for confounders, the excess risk of PCI relative to CABG for death/MI/stroke remained significant (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.13 to 1.68, p = 0.002). The excess risks of PCI relative to CABG for all-cause death, MI, and any coronary revascularization were also significant (HR 1.38, 95% CI 1.10 to 1.74, p = 0.006; HR 2.81, 95% CI 1.69 to 4.66, p <0.001; and HR 4.10, 95% CI 3.32 to 5.06, p <0.001, respectively). The risk for stroke was not significantly different between the PCI and CABG groups (HR 0.88, 95% CI 0.61 to 1.26, p = 0.48). There were no interactions for the primary outcome measure between the mode of revascularization (PCI or CABG) and the subgroup factors such as age, diabetes, and Synergy Between PCI With Taxus and Cardiac Surgery score. In conclusion, CABG compared with PCI was associated with better long-term outcome in patients with TVD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mohr F.W.
        • Morice M.C.
        • Kappetein A.P.
        • Feldman T.E.
        • Ståhle E.
        • Colombo A.
        • Mack M.J.
        • Holmes D.R.
        • Morel M.A.
        • Dyck N.V.
        • Houle V.M.
        • Dawkins K.D.
        • Serruys P.W.
        Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
        Lancet. 2013; 381: 629-638
        • Head S.J.
        • Davierwala P.M.
        • Serruys P.W.
        • Redwood S.R.
        • Colombo A.
        • Mack M.J.
        • Morice M.C.
        • Holmes Jr., D.R.
        • Feldman T.E.
        • Stahle E.
        • Underwood P.
        • Dawkins K.D.
        • Kappetein A.P.
        • Mohr F.W.
        Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the syntax trial.
        Eur Heart J. 2014; 35: 2821-2830
        • Serruys P.W.
        • Onuma Y.
        • Garg S.
        • Vranckx P.
        • De Bruyne B.
        • Morice M.C.
        • Colombo A.
        • Macaya C.
        • Richardt G.
        • Fajadet J.
        • Hamm C.
        • Schuijer M.
        • Rademaker T.
        • Wittebols K.
        • Stoll H.P.
        • ARTS II Investigators
        5-Year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions.
        J Am Coll Cardiol. 2010; 55: 1093-1101
        • Park D.W.
        • Kim Y.H.
        • Song H.G.
        • Ahn J.M.
        • Oh J.
        • Kim W.J.
        • Lee J.Y.
        • Kang S.J.
        • Lee S.W.
        • Lee C.W.
        • Park S.W.
        • Yun S.C.
        • Jung S.H.
        • Choo S.J.
        • Chung C.H.
        • Lee J.W.
        • Park S.J.
        Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the ASAN Medical Center-Multivessel Revascularization Registry.
        J Am Coll Cardiol. 2011; 57: 128-137
        • Tazaki J.
        • Shiomi H.
        • Morimoto T.
        • Imai M.
        • Yamaji K.
        • Sakata R.
        • Okabayashi H.
        • Hanyu M.
        • Shimamoto M.
        • Nishiwaki N.
        • Komiya T.
        • Kimura T.
        Three-year outcome after percutaneous coronary intervention and coronary artery bypass grafting in patients with triple-vessel coronary artery disease: observations from the CREDO-Kyoto PCI/CABG Registry Cohort-2.
        EuroIntervention. 2013; 9: 437-445
        • Kimura T.
        • Morimoto T.
        • Furukawa Y.
        • Nakagawa Y.
        • Kadota K.
        • Iwabuchi M.
        • Shizuta S.
        • Shiomi H.
        • Tada T.
        • Tazaki J.
        • Kato Y.
        • Hayano M.
        • Abe M.
        • Tamura T.
        • Shirotani M.
        • Miki S.
        • Matsuda M.
        • Takahashi M.
        • Ishii K.
        • Tanaka M.
        • Aoyama T.
        • Doi O.
        • Hattori R.
        • Tatami R.
        • Suwa S.
        • Takizawa A.
        • Takatsu Y.
        • Takahashi M.
        • Kato H.
        • Takeda T.
        • Lee J.D.
        • Nohara R.
        • Ogawa H.
        • Tei C.
        • Horie M.
        • Kambara H.
        • Fujiwara H.
        • Mitsudo K.
        • Nobuyoshi M.
        • Kita T.
        Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan.
        Cardiovasc Interv Ther. 2011; 26: 234-245
        • Shiomi H.
        • Morimoto T.
        • Hayano M.
        • Furukawa Y.
        • Nakagawa Y.
        • Tazaki J.
        • Imai M.
        • Yamaji K.
        • Tada T.
        • Natsuaki M.
        • Saijo S.
        • Funakoshi S.
        • Nagao K.
        • Hanazawa K.
        • Ehara N.
        • Kadota K.
        • Iwabuchi M.
        • Shizuta S.
        • Abe M.
        • Sakata R.
        • Okabayashi H.
        • Hanyu M.
        • Yamazaki F.
        • Shimamoto M.
        • Nishiwaki N.
        • Imoto Y.
        • Komiya T.
        • Horie M.
        • Fujiwara H.
        • Mitsudo K.
        • Nobuyoshi M.
        • Kita T.
        • Kimura T.
        Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).
        Am J Cardiol. 2012; 110: 924-932
        • Serruys P.W.
        • Unger F.
        • Sousa J.E.
        • Jatene A.
        • Bonnier H.J.
        • Schonberger J.P.
        • Buller N.
        • Bonser R.
        • van den Brand M.J.
        • van Herwerden L.A.
        • Morel M.A.
        • van Hout B.A.
        Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.
        N Engl J Med. 2001; 344: 1117-1124
      1. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO Investigators.
        N Engl J Med. 1993; 329: 673-682
        • Shiomi H.
        • Morimoto T.
        • Makiyama T.
        • Ono K.
        • Furukawa Y.
        • Nakagawa Y.
        • Kadota K.
        • Onodera T.
        • Takatsu Y.
        • Mitsudo K.
        • Kita T.
        • Sakata R.
        • Okabayashi H.
        • Hanyu M.
        • Komiya T.
        • Yamazaki F.
        • Nishiwaki N.
        • Kimura T.
        Evolution in practice patterns and long-term outcomes of coronary revascularization from bare-metal stent era to drug-eluting stent era in Japan.
        Am J Cardiol. 2014; 113: 1652-1659
        • Epstein A.J.
        • Polsky D.
        • Yang F.
        • Yang L.
        • Groeneveld P.W.
        Coronary revascularization trends in the United States, 2001-2008.
        JAMA. 2011; 305: 1769-1776
        • Hassan A.
        • Newman A.
        • Ko D.T.
        • Rinfret S.
        • Hirsch G.
        • Ghali W.A.
        • Tu J.V.
        Increasing rates of angioplasty versus bypass surgery in Canada, 1994-2005.
        Am Heart J. 2010; 160: 958-965
        • Kimura T.
        • Morimoto T.
        • Nakagawa Y.
        • Kawai K.
        • Miyazaki S.
        • Muramatsu T.
        • Shiode N.
        • Namura M.
        • Sone T.
        • Oshima S.
        • Nishikawa H.
        • Hiasa Y.
        • Hayashi Y.
        • Nobuyoshi M.
        • Mitudo K.
        • j-Cypher Registry Investigators
        Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry.
        Circulation. 2012; 125: 584-591
        • Nakagawa Y.
        • Kimura T.
        • Morimoto T.
        • Nomura M.
        • Saku K.
        • Haruta S.
        • Muramatsu T.
        • Nobuyoshi M.
        • Kadota K.
        • Fujita H.
        • Tatami R.
        • Shiode N.
        • Nishikawa H.
        • Shibata Y.
        • Miyazaki S.
        • Murata Y.
        • Honda T.
        • Kawasaki T.
        • Doi O.
        • Hiasa Y.
        • Hayashi Y.
        • Matsuzaki M.
        • Mitsudo K.
        Incidence and risk factors of late target lesion revascularization after sirolimus-eluting stent implantation (3-year follow-up of the j-Cypher Registry).
        Am J Cardiol. 2010; 106: 329-336
        • Park K.W.
        • Kim C.H.
        • Lee H.Y.
        • Kang H.J.
        • Koo B.K.
        • Oh B.H.
        • Park Y.B.
        • Kim H.S.
        Does “late catch-up” exist in drug-eluting stents: insights from a serial quantitative coronary angiography analysis of sirolimus versus paclitaxel-eluting stents.
        Am Heart J. 2010; 159: 446-453
        • Iijima R.
        • Araki T.
        • Nagashima Y.
        • Yamazaki K.
        • Utsunomiya M.
        • Hori M.
        • Itaya H.
        • Shinji H.
        • Shiba M.
        • Hara H.
        • Nakamura M.
        • Sugi K.
        Incidence and predictors of the late catch-up phenomenon after drug-eluting stent implantation.
        Int J Cardiol. 2013; 168: 2588-2592
        • Farkouh M.E.
        • Domanski M.
        • Sleeper L.A.
        • Siami F.S.
        • Dangas G.
        • Mack M.
        • Yang M.
        • Cohen D.J.
        • Rosenberg Y.
        • Solomon S.D.
        • Desai A.S.
        • Gersh B.J.
        • Magnuson E.A.
        • Lansky A.
        • Boineau R.
        • Weinberger J.
        • Ramanathan K.
        • Sousa J.E.
        • Rankin J.
        • Bhargava B.
        • Buse J.
        • Hueb W.
        • Smith C.R.
        • Muratov V.
        • Bansilal S.
        • King III, S.
        • Bertrand M.
        • Fuster V.
        • Investigators
        Strategies for multivessel revascularization in patients with diabetes.
        N Engl J Med. 2012; 367: 2375-2384
        • Weintraub W.S.
        • Grau-Sepulveda M.V.
        • Weiss J.M.
        • O'Brien S.M.
        • Peterson E.D.
        • Kolm P.
        • Zhang Z.
        • Klein L.W.
        • Shaw R.E.
        • McKay C.
        • Ritzenthaler L.L.
        • Popma J.J.
        • Messenger J.C.
        • Shahian D.M.
        • Grover F.L.
        • Mayer J.E.
        • Shewan C.M.
        • Garratt K.N.
        • Moussa I.D.
        • Dangas G.D.
        • Edwards F.H.
        Comparative effectiveness of revascularization strategies.
        N Engl J Med. 2012; 366: 1467-1476
        • Kappetein A.P.
        • Feldman T.E.
        • Mack M.J.
        • Morice M.C.
        • Holmes D.R.
        • Stahle E.
        • Dawkins K.D.
        • Mohr F.W.
        • Serruys P.W.
        • Colombo A.
        Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial.
        Eur Heart J. 2011; 32: 2125-2134
        • Kappetein A.P.
        • Head S.J.
        • Morice M.C.
        • Banning A.P.
        • Serruys P.W.
        • Mohr F.W.
        • Dawkins K.D.
        • Mack M.J.
        Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial.
        Eur J Cardiothorac Surg. 2013; 43: 1006-1013
        • Kimura T.
        • Morimoto T.
        • Natsuaki M.
        • Shiomi H.
        • Igarashi K.
        • Kadota K.
        • Tanabe K.
        • Morino Y.
        • Akasaka T.
        • Takatsu Y.
        • Nishikawa H.
        • Yamamoto Y.
        • Nakagawa Y.
        • Hayashi Y.
        • Iwabuchi M.
        • Umeda H.
        • Kawai K.
        • Okada H.
        • Kimura K.
        • Simonton C.A.
        • Kozuma K.
        Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent trial (RESET).
        Circulation. 2012; 126: 1225-1236
        • Natsuaki M.
        • Kozuma K.
        • Morimoto T.
        • Kadota K.
        • Muramatsu T.
        • Nakagawa Y.
        • Akasaka T.
        • Igarashi K.
        • Tanabe K.
        • Morino Y.
        • Ishikawa T.
        • Nishikawa H.
        • Awata M.
        • Abe M.
        • Okada H.
        • Takatsu Y.
        • Ogata N.
        • Kimura K.
        • Urasawa K.
        • Tarutani Y.
        • Shiode N.
        • Kimura T.
        Biodegradable polymer biolimus-eluting stent versus durable polymer everolimus-eluting stent: a randomized, controlled, noninferiority trial.
        J Am Coll Cardiol. 2013; 62: 181-190
        • Wallentin L.
        • Becker R.C.
        • Budaj A.
        • Cannon C.P.
        • Emanuelsson H.
        • Held C.
        • Horrow J.
        • Husted S.
        • James S.
        • Katus H.
        • Mahaffey K.W.
        • Scirica B.M.
        • Skene A.
        • Steg P.G.
        • Storey R.F.
        • Harrington R.A.
        • Freij A.
        • Thorsen M.
        Ticagrelor versus clopidogrel in patients with acute coronary syndromes.
        N Engl J Med. 2009; 361: 1045-1057
        • Roe M.T.
        • Armstrong P.W.
        • Fox K.A.
        • White H.D.
        • Prabhakaran D.
        • Goodman S.G.
        • Cornel J.H.
        • Bhatt D.L.
        • Clemmensen P.
        • Martinez F.
        • Ardissino D.
        • Nicolau J.C.
        • Boden W.E.
        • Gurbel P.A.
        • Ruzyllo W.
        • Dalby A.J.
        • McGuire D.K.
        • Leiva-Pons J.L.
        • Parkhomenko A.
        • Gottlieb S.
        • Topacio G.O.
        • Hamm C.
        • Pavlides G.
        • Goudev A.R.
        • Oto A.
        • Tseng C.D.
        • Merkely B.
        • Gasparovic V.
        • Corbalan R.
        • Cinteza M.
        • McLendon R.C.
        • Winters K.J.
        • Brown E.B.
        • Lokhnygina Y.
        • Aylward P.E.
        • Huber K.
        • Hochman J.S.
        • Ohman E.M.
        Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.
        N Engl J Med. 2012; 367: 1297-1309
        • Shiomi H.
        • Kozuma K.
        • Morimoto T.
        • Igarashi K.
        • Kadota K.
        • Tanabe K.
        • Morino Y.
        • Akasaka T.
        • Abe M.
        • Suwa S.
        • Muramatsu T.
        • Kobayashi M.
        • Dai K.
        • Nakao K.
        • Uematsu M.
        • Tarutani Y.
        • Fujii K.
        • Simonton C.A.
        • Kimura T.
        Long-term clinical outcomes after everolimus- and sirolimus-eluting coronary stent implantation: final 3-year follow-up of the randomized evaluation of sirolimus-eluting versus everolimus-eluting stent trial.
        Circ Cardiovasc Interv. 2014; 7: 343-354
        • Raber L.
        • Magro M.
        • Stefanini G.G.
        • Kalesan B.
        • van Domburg R.T.
        • Onuma Y.
        • Wenaweser P.
        • Daemen J.
        • Meier B.
        • Juni P.
        • Serruys P.W.
        • Windecker S.
        Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study.
        Circulation. 2012; 125: 1110-1121
        • Tada T.
        • Byrne R.A.
        • Simunovic I.
        • King L.A.
        • Cassese S.
        • Joner M.
        • Fusaro M.
        • Schneider S.
        • Schulz S.
        • Ibrahim T.
        • Ott I.
        • Massberg S.
        • Laugwitz K.L.
        • Kastrati A.
        Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients.
        JACC Cardiovasc Interv. 2013; 6: 1267-1274
        • Palmerini T.
        • Biondi-Zoccai G.
        • Della Riva D.
        • Stettler C.
        • Sangiorgi D.
        • D'Ascenzo F.
        • Kimura T.
        • Briguori C.
        • Sabate M.
        • Kim H.S.
        • De Waha A.
        • Kedhi E.
        • Smits P.C.
        • Kaiser C.
        • Sardella G.
        • Marullo A.
        • Kirtane A.J.
        • Leon M.B.
        • Stone G.W.
        Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
        Lancet. 2012; 379: 1393-1402
        • Tonino P.A.
        • De Bruyne B.
        • Pijls N.H.
        • Siebert U.
        • Ikeno F.
        • van' t Veer M.
        • Klauss V.
        • Manoharan G.
        • Engstrom T.
        • Oldroyd K.G.
        • Ver Lee P.N.
        • MacCarthy P.A.
        • Fearon W.F.
        Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
        N Engl J Med. 2009; 360: 213-224