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Comparison of three-year outcome after PCI and CABG stratified by the SYNTAX score in patients with triple vessel coronary artery disease: an observation from the CREDO-Kyoto PCI/CABG registry Cohort-2

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Hiroki Shiomi Hiroki Shiomi(Japan)

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List of Authors:
Shiomi Hiroki, Furukawa Yutaka, Morimoto Takeshi, Shizuta Satoshi, Hayano Mamoru, Tazaki Junichi, Imai Masao, Yamaji Kyohei, Hanazawa Koji, Nagao Kazuya, Saijo Sayaka, Funakoshi Shunsuke, Komiya Tatsuhiko, Sakata Ryuzo, Okabayashi Hitoshi, Hanyu Michiya, Nishiwaki Noboru, Shimamoto Mitsuomi, Kimura Takeshi


Backgrounds: Long-term outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with triple vessel coronary artery disease (TVD) remains to be elucidated.

Objective: We sought to compare long-term outcome after PCI and CABG in TVD patients stratified by the SYNTAX score.

Methods: We identified 2981 patients with TVD (PCI: N=1825, CABG: N=1156) among 15263 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. Main outcome measure of the current analysis is a composite of death/myocardial infarction (MI)/stroke .

Results: PCI as compared with CABG was associated with higher 3-year risk for the primary endpoint (adjusted hazard ratio (HR) 1.47 [95% confidence interval (CI): 1.13-1.92, P=.004]), and MI (HR 2.39 [95%CI: 1.31-4.36, P=.004]). Although the risk for all-cause death was significantly higher after PCI (HR 1.62 [95%CI: 1.16-2.27, P=.005]), risk for cardiac death was not significantly different (HR 1.30 [95%CI: 0.81-2.07, P=.28]). Cumulative incidence of the primary endpoint was not different between the PCI and CABG groups in patients with low (<23, N=874 and N=257) and intermediate SYNTAX score (23-32, N=638 and N=388), while in patients with high SYNTAX score (≥ 33, N=280 and N=375), it was markedly higher after PCI than after CABG (15.8% and 12.5%, P=.25, 18.8% and 16.7%, P=.24, and 27.0% and 16.4%, P=.004, respectively). However, the adjusted risk of PCI relative to CABG for the primary endpoint was HR 1.66 (95% CI: 1.04-2.65, P=.03) in the low-score category, HR 1.24 (95% CI: 0.83-1.85, P=.29) in the intermediate-score category, and HR 1.59 (95% CI: 0.998-2.54, P=.051) in the high-score category, respectively.

Conclusions: PCI as compared with CABG was associated with significantly higher risk for serious adverse events in TVD patients. Further studies are warranted to investigate whether PCI could be a viable option in TVD patients with less complex coronary anatomy.

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Frans Van de Werf(Belgium)

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The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.