Comparative Study on PCI vs. CABG for Women with Multivessel Coronary Artery Disease

A comprehensive retrospective study comparing the outcomes of two common treatments, percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), for women with multivessel coronary artery disease reveals crucial differences in long-term results. The researchers found that CABG is associated with lower six-year mortality among women with multivessel disease.

This study was published in The Journal Of Thoracic and Cardiovascular Surgery by Edward Hannan and colleagues.

Research Overview

The research, conducted using the New York State cardiac registry data from 2012 to 2018, assessed outcomes in women with multivessel coronary artery disease who underwent either PCI with everolimus-eluting stents or CABG. Here are the primary findings:

• Mortality Risk: PCI was associated with a higher six-year risk of mortality compared to CABG (25.75% vs. 23.57%).
• Composite Major Adverse Cardiac Events: PCI showed a higher rate of the composite outcome of death, myocardial infarction, and stroke (36.58% vs. 32.89%).
• Myocardial Infarction: Patients undergoing PCI had a significantly higher rate of myocardial infarction compared to those undergoing CABG (14.94% vs. 9.12%).
• Stroke: There was no significant difference in stroke rates between the two interventions.
• Repeat Revascularization: PCI was associated with higher rates of repeat revascularization (21.53% vs. 11.57%).

The study's analysis suggests that for women with multivessel coronary artery disease, CABG appears to offer more favorable long-term outcomes compared to PCI with everolimus-eluting stents. The findings highlight the importance of considering the optimal treatment strategy, especially for female patients with this specific condition.

Additional Insights

• No Mortality Difference in Certain Groups: Notably, when PCI patients received complete revascularization or had non-complex lesions, and among women without diabetes, there was no significant mortality difference between the interventions.
• Lower Repeat Revascularization with CABG: The study also underscores the advantage of CABG over PCI in reducing the need for repeat revascularization procedures in this patient population.

The study findings highlight the importance of weighing the risks and benefits of different treatment strategies for women with multivessel coronary artery disease. While PCI with everolimus-eluting stents remains a viable option, the study suggests that CABG might offer more favorable long-term outcomes, emphasizing the need for individualized treatment approaches in clinical practice.

Reference

Hannan, E. L., Wu, Y., Harik, L., Tamis-Holland, J., Jacobs, A. K., Chikwe, J., Cozzens, K. S., & Gaudino, M. Coronary artery bypass surgery vs. Percutaneous interventions for women with multivessel coronary artery disease. The Journal of Thoracic and Cardiovascular Surgery, 2023. https://doi.org/10.1016/j.jtcvs.2023.12.009