Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3

• Published in: PloS one Vol. 17; no. 9; p. e0267906
• Main Authors: Watanabe, Hiroki, Yamamoto, Ko, Shiomi, Hiroki, Morimoto, Takeshi, Kato, Eri, Matsumura, Yukiko, Nakatsuma, Kenji, Takeji, Yasuaki, Yaku, Hidenori, Yamamoto, Erika, Yamashita, Yugo, Yoshikawa, Yusuke, Fuki, Masayuki, Yamaji, Kyohei, Ehara, Natsuhiko, Sakamoto, Hiroki, Imada, Kazuaki, Tada, Takeshi, Taniguchi, Ryoji, Nishikawa, Ryusuke, Tada, Tomohisa, Uegaito, Takashi, Ogawa, Tatsuya, Yamada, Miho, Takeda, Teruki, Eizawa, Hiroshi, Tamura, Nobushige, Tambara, Keiichi, Suwa, Satoru, Shirotani, Manabu, Tamura, Toshihiro, Inoko, Moriaki, Nishizawa, Junichiro, Natsuaki, Masahiro, Sakai, Hiroshi, Yamamoto, Takashi, Kanemitsu, Naoki, Ohno, Nobuhisa, Ishii, Katsuhisa, Marui, Akira, Tsuneyoshi, Hiroshi, Terai, Yasuhiko, Nakayama, Shogo, Yamazaki, Kazuhiro, Takahashi, Mamoru, Tamura, Takashi, Esaki, Jiro, Miki, Shinji, Onodera, Tomoya, Mabuchi, Hiroshi, Furukawa, Yutaka, Tanaka, Masaru, Komiya, Tatsuhiko, Soga, Yoshiharu, Hanyu, Michiya, Ando, Kenji, Kadota, Kazushige, Minatoya, Kenji, Nakagawa, Yoshihisa, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 29.09.2022; Public Library of Science (PLoS)
• Subjects: Angioplasty; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Cerebral infarction; Clinical outcomes; Clinical trials; Complications and side effects; Coronary artery; Coronary artery bypass; Coronary artery disease; Coronary heart disease; Coronary vessels; Diabetes; Drug delivery; Emergency procedures; Evaluation; Frailty; Grafting; Health risks; Heart attacks; Heart diseases; Heart failure; Heart surgery; Hemodialysis; Implants; Ischemia; Kidney diseases; Medicine and Health Sciences; Myocardial infarction; Observational studies; Patient outcomes; Population studies; Risk; Stent (Surgery); Stents; Stroke; Thrombosis; Vein & artery diseases; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267906

There is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease. The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04-1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96-1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79-1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05-2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06-3.43, P<0.0001). In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.