Coronary Artery Bypass Surgery vs. Percutaneous Interventions for Women with Multivessel Coronary Artery Disease.
Academic Article
Overview
abstract
OBJECTIVE: To compare outcomes in women undergoing percutaneous coronary intervention and coronary artery bypass graft surgery. DESIGN: Retrospective, propensity-score matched cohort study from the New York State cardiac registry (2012-2018) of all women with multivessel coronary artery disease undergoing percutaneous coronary intervention with everolimus-eluting stents and coronary artery bypass graft surgery. The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as the composite of all-cause mortality, myocardial infarction, and stroke. RESULTS: Percutaneous coronary intervention with everolimus-eluting stents was associated with a higher six-year risk of mortality (25.75% vs. 23.57%; adjusted hazard ratio=1.29, 95% confidence interval 1.14, 1.45). Percutaneous intervention was also associated with a higher rate of the composite of death, myocardial infarction, and stroke (36.58% vs. 32.89%, adjusted hazard ratio=1.28, 95% confidence interval 1.17, 1.41), as well as myocardial infarction (14.94% vs. 9.12%, adjusted hazard ratio=1.84, 95% confidence interval: 1.56, 2.17), but not stroke (7.07% vs. 7.62%, adjusted hazard ratio=0.83, 95% confidence interval: 0.67, 1.03). Repeat revascularization rates were also higher for women undergoing percutaneous coronary intervention (21.53% vs. 11.57%, adjusted hazard ratio=1.88, 95% confidence interval: 1.63, 2.17). There was no mortality difference between the two interventions when percutaneous coronary intervention patients received complete revascularization, or had non-complex lesions, and for women without diabetes. CONCLUSIONS: For women with multivessel coronary artery disease, coronary artery bypass graft surgery is associated with lower six-year mortality, myocardial infarction, and repeat revascularization rates in comparison to percutaneous coronary intervention with everolimus-eluting stents.
