CABG leads to better survival than PCI
MedWire News: Patients aged 65 years or over with multivessel coronary disease who undergo coronary artery bypass graft surgery (CABG) have a better chance of survival than those who undergo percutaneous coronary intervention (PCI), researchers say.
The study, which was published in the New England Journal of Medicine to coincide with its presentation at the American College of Cardiology's 61st Annual Scientific Sessions in Chicago, is the "most comprehensive sample to date of revascularization outcomes in US patients of 65 years or older," says editorialist Laura Mauri (Harvard Medical School, Boston, Massachusetts, USA).
For the observational study, William Weintraub (Christiana Care Health System, Newark, Delaware, USA) and team linked the American College of Cardiology Foundation National Cardiovascular Data Registry and the Society of Thoracic Surgeons Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid services (2004-2008).
Of the patients aged 65 years or older who had two- or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years.
At 1 year, there was no significant difference in mortality between the groups.
However, at 4 years, patients who underwent CABG had a significantly lower mortality rate than those who underwent PCI (16.4 vs 20.8%), at a risk ratio of 0.79.
Similar results were obtained in multiple subgroup analyses and when using several different analytic methods.
The authors say that since their study was an observational one, it better reflects real-world practice than randomized trials do.
Although Mauri agrees that observational studies provide relevant detail, she says: "there is no substitute for randomized trials to eliminate selection bias between treatments. The two approaches are thus complementary."
She concludes: "We must continue to give priority to randomized trials on the most salient questions regarding treatment strategy and to simplify their design and conduct to be more inclusive and efficient."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra