NEW YORK (Reuters Health) – Long-term outcomes are better for patients with three-vessel coronary artery disease when they undergo off-pump coronary artery bypass grafting rather than percutaneous coronary intervention with a drug-eluting stent (DES), according to the results of a Korean study.
“Freedom from nonfatal myocardial infarction and target vessel revascularization rates were the determining factors between the 2 groups,” explain the authors of the report in the American Journal of Cardiology online December 19.
Dr. Kyung-Jong Yoo, at Yonsei University College of Medicine in Seoul, and colleagues point out that there have been numerous studies comparing outcomes with CABG versus PCI with DESs, but few long-term results comparing off-pump coronary artery bypass grafting (OPCAB) to PCI-DES have been published.
Their current report describes long-term outcomes in 290 propensity-matched patients with three-vessel coronary artery disease who were initially treated with DESs or OPCAB. Follow up ranged from 2 to 73 months, with a mean of 58.8 months.
The primary endpoint was the occurrence of any major adverse cardiac and cerebrovascular event (MACCE), defined as death from any cause, nonfatal myocardial infarction, stroke, and target vessel revascularization.
Five-year rates of freedom from MACCEs were 71.6% in the DES group and 89.6 5% in the OPCAB group (p<0.001), the team reports.
The difference between the DES and OPCAB groups was driven by rates of nonfatal MI (3.4% vs 0%, respectively) and target vessel revascularization (18.6% vs 4.8%). Mortality was not significantly different in the two groups (4.1% vs 3.4%) and rates of stroke were the same (2.8%), Dr. Yoo and colleagues found.
They acknowledge that this was not a randomized trial, although they used propensity-score analysis for patient matching. Also, the numbers in each group were relatively small.
Nonetheless, they conclude, “In our study, the OPCAB group showed better clinical outcomes compared to the DES group after 59-month follow- up.” Still, they add, “Longer follow-up with randomization will clarify our present results.”
SOURCE:
Am J Cardiol 2012.
