• Lower Mortality Risk for Left Main Revascularization with CABG vs. PCI in National Swedish Registry

    Coronary artery bypass graft (CABG) carried a lower mortality risk in non-ST-elevation myocardial infarction (NSTEMI) patients undergoing revascularization for left main coronary artery disease (LM CAD) than percutaneous coronary intervention (PCI) in the latest analysis of a national online Swedish registry.

    The Swedish Coronary Angiography and Angioplasty Registry (SCAAR) analysis also found that the benefit of CABG was highest in younger patients with longer life expectancy.

    The findings were presented Monday at the Transcatheter Cardiovascular Therapeutics (TCT) 2022 conference in Boston by Elmir Omerovic MD, PhD, from Sahlgrenska University Hospital in Gothenburg, Sweden.

    It has been unclear whether either revascularization strategy carries benefit in LM CAD setting since few previous studies have compared CABG with PCI, said Omerovic.

    The current study, therefore, set out to compare PCI and CABG strategies on all-cause mortality in the unselected SCAAR population, including all NSTEMI patients with either stable or unstable angina (SA/UA/NSTEMI) who underwent coronary angiography for LM CAD (>50% stenosis) between 2015 and 2022 in Sweden. SCAAR has recorded all angiographies and PCIs in Sweden since 1989 across 30 hospitals.

    The analysis includes a total 10,254 patients, 5,391 (52.6%) of whom underwent PCI and 4,863 (47.4%) who underwent CABG.

    Age (a mean 74 years for PCI and 70 years for CABG), gender (81% male vs. 79% male, respectively), body mass index (mean of 27 kg/m2 in both groups) and diabetes status (69% vs. 72%, respectively) were similarly weighted between the study groups.   

    There was a larger number of hypertensive patients in CABG (82%) than in PCI (71%), but a greater percentage with hyperlipidemia in PCI (75% vs. 59%, respectively). The PCI group also had more patients with previous MI (42% vs. 18%, respectively), more with previous PCI (38% vs. 15%) and more with previous CABG (36% vs. 1%).

    The researchers adjusted for known and unknown confounders using multilevel Cox proportional-hazards regression with instrumental variable and inverse probability weighting propensity score.

    CABG was associated with lower mortality risk in SA/UA/NSTEMI patients undergoing revascularization for LM CAD (adjusted hazard ratio [HR] for PCI: 1.59; 95% confidence interval [CI]: 1.11-2.27; P = 0.011), said Omerovic.

    "Expressed another way," this means that "if you expect to live up to 7 years […] you will gain on average half a year. If you are expected to live less than 2 years, it will be less than 1 month," he said.

    Omerovic went on to note some important differences among subgroups, stressing that patients older than 80 years had lower mortality with PCI.

    Image Credit: Jason Wermers/CRTonline.org

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