Clinical Outcome Of Percutaneous Coronary Intervention Versus Bypass Surgery For Patients With Coronary Artery Disease

Objection:Drug-eluting stents(DESs) provide superior long-tern results compared with bare metal stents in patients with coronary heart disease.However, off-pump coronary artery bypass surgery(OPCABG) may limit the rate of perioperative morbidity.The present study accessed the effect of DESs versus OPCABG on 3-year outcome of patients with coronary artery disease in real world.Method:Retrospectively analyze 231 patients who were diagnosed coronary artery disease by angiography in Zhongshan Hospital between January 2004 and November 2006.The study population included 57 diabetic patients.According to their strategies of coronary artery revascularization,they were divided into two groups: PCI group(n=101) and CABG group(n=130).The patients with any previous myocardial revascularization(percutanerous and/or surgical) were excluded.The patients general condition,outcome of angiography and clinical course were recorded during the stay in hospital.The follow-up were made by telephone and letter from January to March in 2008 for 36.32±7.55 months.Subgroup analyses were performed on diabetics versus non-diabetics and single-versus multi-vessel disease. The primary end point was defined as the following major adverse cardiac and cerebral events(MACCE):death(all-cause mortality),cerebrovascular accident, documented non-fatal myocardial infraction adjudicated by either new abnormal Q-wave or predefined enzymatic changes,or repeat revascularization by coronary stentig or CABG,and anginal status.Results:Angiographic characteristics:23.1%of the patients in CABG group had left main coronary artery stenosis,versus 5.0%of those in PCI group(P＜0.001). There were more patients with one-or two vessel disease in PCI group,while most patients in CABG group had three-vessel disease(76.2%versus 17.8%,P＜0.001). In-hospital outcomes:Patients who underwent stenting had a mortality rate of 1.0% versus 3.8%in those who underwent OPCAB(P=0.349;OR,0.349;95%CI, 0.031～2.169).There was no significant difference in the rate of cerebrovascular accident,MI and MACCEs between the PCI and CAGB group(P＞0.05).Three year outcomes:The mortality in two groups was significant different.Death occurred in 10.8%in CABG group versus 3.0%in PCI group(P=0.024;OR,0.276;95%CI, 0.081～0.934).However,the patients in PCI group had a higher rate of additional revascularization(12.9%versus 1.5%;P=0.001;OR,8.366;95%CI,1.932～36.236). Single-versus multi-vessel treatment:There were 39 patients in PCI group had single-vessel disease and 14 patients in CABG group.There was no significant difference in the rate of death,cerebrovascular event,MI and MACCEs between the two groups(P＞0.05).There were 62 patients in PCI group had multi-vessel disease and 126 patients in CABG group.The patients in PCI group had a higher rate of revascularization(16.1%versus 1.6%;P＜0.001) and angina(22.6%versus 11.1%;P =0.038).There was no significant difference in the rate of death,cerebrovascular event,MI and MACCEs between the two groups(P＞0.05).Patients with diabetes: The study population included 57 diabetic patients:18 in PCI group,39 in CABG group(P=0.033).The uneventful survival rate observed of 87.2%in CABG group versus 33.3%in PCI group(P＜0.001;OR,5.200;95%CI,2.154～12.552).However, the patients in PCI group had a higher rate of additional revascularization(50.0% versus 0;P＜0.001) and angina(77.8%versus 20.5%;P＜0.001).In patients without diabetes,those who underwent stenting(n=83) had a mortality rate of 1.2%versus 11.0%in those who underwent CABG(n=91)(P=0.008;OR,0.110;95%CI, 0.014～0.838).There was no significant difference in the rate of MI,additional revascularization and angina between the two groups(P＞0.05).The uneventful survival rate obtained of 84.6%in CABG group versus 95.2%in PCI group (OR,0.313;95%CI,0.107～0.914;P=0.022).Conclusion:There was no significant difference in the rate of death, cerebrovascular accident and MI between PCI group and CABG group.At three years, the patients in CABG group had a higher rate of death.The MACCEs occurred similar in two groups,however,the patients who underwent stenting had higher rate of additional revascularization.There is no significant difference between the two treatment in patients with single-vessel disease.In patients with multi-vessel disease, the uneventful survival rate was similar between the two groups,however,the patients who underwent stenting had a higher rate of additional revascularization and angina. The patients with diabetes who underwent OPCAB had higher rate of uneventful survival because the patients who underwent stenting had higher rate of additional revascularization,MACCEs and angina.The patients without diabetes who underwent CABG had higher rate of death and cerebrovascular accident while there was no significant difference between two groups.