Propensity score-matched analysis of coronary artery bypass grafting versus second-generation drug-eluting stents for triple-vessel disease

Abstract

Objectives: This study aimed to compare the mid-term results of coronary artery bypass grafting (CABG) with those of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DESs) for triple-vessel disease.

Methods: Between February 2010 and December 2015, 607 patients underwent primary isolated CABG and 264 patients underwent PCI with second-generation DESs (everolimus-eluting stent, biolimus-eluting stent or zotarolimus-eluting stent) for triple-vessel disease with or without left main disease. We compared the CABG group with the second-generation DES group using propensity score matching analysis. The study end points were major adverse cardiac and cerebrovascular events.

Results: After propensity score matching, 238 pairs of patients were successfully matched (C-statistic 0.762). The mean number of distal anastomoses in the CABG group was 4.7 and that of implanted stents in the second-generation DES group was 2.8. The 30-day mortality was similar between the groups (0.8% vs 0.4%; P = 0.564). The median follow-up period was 3.4 years in the CABG group and 3.8 years in the second-generation DES group. Although there was no significant difference in the incidence of all-cause death and cerebrovascular accidents, the incidence of myocardial infarction [hazard ratio (HR) 11.76; 95% confidence interval (CI) 2.32-214.15, P = 0.003] and repeat revascularization (HR 3.78; 95% CI 2.35-6.38; P < 0.001) was significantly higher in the second-generation DES group than in the CABG group. This resulted in a higher incidence of major adverse cardiac and cerebrovascular events (HR 2.27; 95% CI 1.61-3.24; P < 0.001).

Conclusions: CABG might be superior to PCI with second-generation DESs for treatment of triple-vessel disease in terms of major adverse cardiac and cerebrovascular events.

Keywords: Coronary artery bypass grafting; Major adverse cardiac and cerebrovascular events; Second-generation drug-eluting stent; Triple-vessel disease.