Comparison of coronary artery bypass grafting and stenting depending on the clinical and anatomical scenario: data from the retrospective single-center cohort study

Aim. To assess the long-term all-cause mortality after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with stable coronary artery disease (CAD) under various clinical and anatomical scenarios. Material and methods. This single-center cohort retrospective study assessed the outcomes of CABG and PCI with implantation of second-generation drugeluting stents in 4177 patients with stable CAD. Inhospital, 30-day and remote 5-year all-cause mortality (mean follow-up period — 38 months) was assessed. Also, the influence of the initial severity of CAD, the presence/absence of diabetes, myocardial contractility on remote all-cause mortality after myocardial revascularization was assessed. Results. Inhospital and 30-day risks of death in patients who underwent PCI and CABG, after comparing the initial clinical characteristics, did not differ significantly. In the long-term follow-up period, PCI compared with CABG was associated with an increased all-cause mortality in the main groups (PCI vs CABG: odds ratio (OR) 1,84, 95% confidence interval (CI) 1,30-2,62, p<0,001), as well as in the following subgroups: (1) in patients with multivessel CAD (OR 1,77, 95% CI 1,19-2,64, p=0,005), (2) in patients with left main CAD >50% (OR 5,04, 95% CI 1,72-14,76, p=0,003), but not in patients with single-vessel disease (OR 2,084, 95% CI 0,9964,361, p=0,051). Diabetes in the main study groups did not affect the difference in mortality as follows: CABG had an advantage over PCI regardless of diabetes. However, CABG in patients with multivessel disease and diabetes, in contrast to patients without diabetes, led to a significant decrease in all-cause death risk (OR 2,29, 95% CI 1,173-4,47, p=0,015). Also, PCI compared with CABG was accompanied by an increase in the 5-year death risk in patients with an not reduced left ventricular ejection fraction (LVEF) >40% (OR 1,74, 95% CI 1,205-2,536, p=0,003), but not in patients with LVEF <40% (95% CI 1,314-4,709, p=0,809). Conclusion. The obtained data indicate a significant reduction in the 5-year risk of all-cause mortality in patients undergoing CABG compared to patients after PCI. Potential long-term benefit from CABG compared to PCI may be obtained in patients with complex coronary artery involvement (left main coronary artery stenosis >50%, lesion of two or more coronary arteries), with concomitant diabetes in multivessel disease, and patients with non-reduced LVEF (>40%).