CABG bests PCI for multivessel CAD, large new study confirms
Coronary artery bypass grafting (CABG) is associated with higher survival rate than percutaneous coronary intervention (PCI) among patients presenting with multivessel coronary artery disease, according to new findings to be presented at the 59th Annual Meeting of the Society of Thoracic Surgeons (STS) in San Diego.
“The findings of our study were very convincing,” J. Hunter Mehaffey MD, MSc, a specialist with the department of cardiovascular and thoracic surgery at West Virginia University, said in a prepared statement previewing the conference. “The singular message to the public is that the optimal treatment for multivessel coronary artery disease—to improve not only long-term survival but also lower your risk of complications—is coronary artery bypass surgery.”
Researchers examined data from more than 100,000 patients with multivessel coronary disease. This included approximately 51,000 patients who underwent CABG and approximately 52,000 patients who underwent PCI. Overall, the study found that CABG patients from this cohort were less likely to die while hospitalized for their procedure—and they were less likely to require an additional stenting procedure or related intervention in the following three years.
Additional context on this CABG vs PCI research
The group’s analysis was in part a response to the coronary artery revascularization guidelines developed by the American College of Cardiology, American Heart Association and Society for Cardiovascular Angiography and Interventions in 2021. One of the primary updates from those guidelines was that CABG was downgraded from a class 1 recommendation to a class 2B recommendation—a change that Mehaffey said “really shocked” cardiac surgeons.
“Much of this decision to downgrade was based on the guideline committee’s goals to focus on the most recent data, to ensure that they were capturing contemporary stent technology, so they only evaluated studies published within the past five years,” Mehaffey said in the same prepared statement. “Therefore, these guidelines relied heavily on the recently publicized ISCHEMIA trial, which looked at medical therapy in coronary artery disease, comparing an initial invasive approach versus a conservative approach to patients who had stable coronary artery disease.”
The ISCHEMIA trial, according to Mehaffey and colleagues, did not accurately represent the average patients who may be eligible for CABG in the United States.
Findings from the team’s new study, “Contemporary Artery Bypass Grafting versus Multivessel Percutaneous Coronary Intervention in 100,000 Matched Medicare Beneficiaries,” are scheduled to be shared with the meeting attendees on the morning of Sunday, Jan. 22. The 59th Annual Meeting of the STS takes place Jan. 21-23 at the San Diego Convention Center.
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.