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Surgery may be better than PCI in patients with multivessel disease at high risk.

With Multivessel Disease at High Risk Coronary artery bypass graft surgery was associated with lower risk of mortality in patients with multivessel coronary artery disease and high-risk characteristics than was percutaneous intervention, said researchers from the Cleveland Clinic Foundation in a report in this week’s issue of the journal Circulation (Circulation. 2004;109:2290–2295). In the study, researchers led by Sorin J. Brener, MD, studied 6033 consecutive subjects who underwent revascularization during the last decade. Percutaneous interventions were carried out in 872 of them and surgery was performed on 5161. A total of 931 deaths were recorded during 5 years’ follow-up. The 1-year mortality rates were 5% for PCI and 4% for coronary artery bypass graft surgery. The 5-year mortality rates were 16% for PCI and 14% for CABG. Percutaneous intervention was associated with an increased risk of death with an adjusted hazard ratio of 2.3. The researchers noted that the comparison is affected by procedure selection bias, duration of follow-up, and type of event. The researchers wrote: “Despite these limitations, we conclude that at a large tertiary institution with particularly low surgical mortality, patients with multivessel CAD [coronary artery disease] and many high-risk features appear to have a better 5-year survival when treated with CABG than with PCI. Further research is needed to determine whether drug-eluting stents and improved medical management will close the mortality gap in these patients.”