Surgery outperforms PCI in NSTEMI patients with multivessel CAD
Bypass surgery is associated with better long-term outcomes than percutaneous coronary intervention (PCI) when treating patients who present with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease, according to new research published in European Heart Journal.[1]
Researchers tracked more than 57,000 patients with NSTEMI and multivessel coronary artery disease (CAD) who underwent treatment from 2005 to 2022. The mean patient age was 68.7 years old, 75.8% were men and the median follow-up period was 7.1 years. All data came from the SWEDEHEART registry, which monitors heart patients treated in Sweden.
While 73.9% of patients underwent PCI, the remaining 26.1% were treated with coronary bypass graft (CABG) surgery. Overall, CABG was linked to significantly lower risks of death, repeat revascularization and heart failure than PCI. The risk of stroke was comparable for both treatment options.
The study also included a variety of subgroup analyses designed to reveal additional relationships between revascularization strategies and patient outcomes. The authors found that CABG was especially beneficial for patients with left ventricular dysfunction, for example, and the type of hospital—high-volume facilities with on-site CABG vs. other locations—did not appear to play a role.
“Our findings indicate that CABG is associated with lower risks of all-cause mortality and myocardial infarction compared with PCI,” wrote first author Elmir Omerovic, a cardiologist and professor of cardiology with the University of Gothenburg in Sweden, and colleagues. “Specifically, the long-term risk of all-cause mortality was 41% lower in the CABG group, and the risk of myocardial infarction was 34% lower. The mortality benefit of CABG over PCI was evident at each yearly follow-up interval.”
Omerovic et al. also called for additional research into different revascularization strategies in NSTEMI patients who present with multivessel CAD.
“Randomized controlled trials with CABG are warranted to compare contemporary PCI techniques, including newer-generation drug-eluting stents and advanced imaging modalities,” the group wrote. “Advances in diagnostic techniques have enabled the detection of minor non-fatal cardiovascular events, often neither associated with symptoms nor affecting quality of life, highlighting the uncertainty in defining clinically relevant non-fatal events and how to account for the competing risk of death. Additionally, exploring the role of hybrid revascularization approaches and personalized medicine strategies could provide valuable insights into optimizing treatment for this complex patient population.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.