CABG vs. PCI for Multivessel CAD: Do Second-Generation Stents Make a Difference? — Physician’s First Watch
CABG vs. PCI for Multivessel CAD: Do Second-Generation Stents Make a Difference?
By Howard C. Herrmann, MD
Second-generation stents narrow the gap between coronary artery bypass grafting and percutaneous coronary intervention for nondiabetic patients with multivessel disease, according to findings from two studies published in the New England Journal of Medicine.
The studies provide a wealth of data informing clinicians and patients about the differences between CABG and PCI for multivessel coronary artery disease. PCI may offer early safety benefits for stroke, bleeding, and potentially mortality, but poses a greater need for repeat revascularization. Later mortality is similar with the two procedures, but MI rates may be higher after PCI. Overall, these data suggest few differences, except for patients with diabetes and for those in whom complete revascularization cannot be attained. This gives the edge to the less invasive approach, which most patients tend to prefer.
The study details:
In a noninferiority study, 880 Asian patients with multivessel disease were randomized to CABG or PCI with everolimus-eluting stents (EESs). At 2 years, the primary endpoint (death, MI, or target-vessel revascularization) was similar in the two groups (PCI, 11%; CABG, 8%), although the difference became statistically significant by 5 years (15% vs. 11%), due primarily to more repeat revascularizations and a trend toward more MIs with PCI. The primary endpoint significantly favored CABG among diabetics, but not among nondiabetics.
In the second study, investigators used registry data to compare outcomes in 9000 multivessel disease patients undergoing PCI with EESs and 9000 undergoing CABG. Early 30-day mortality and stroke were superior with PCI. At 3 years, the groups, including a diabetes subgroup, had similar mortality. Subsequent spontaneous MI was about 1% annually more frequent after PCI than after CABG, but only when revascularization was incomplete.
Dr. Herrmann is deputy editor for NEJM Journal Watch Cardiology, from which this story was adapted.