Thorac Cardiovasc Surg 2019; 67(06): 458-466
DOI: 10.1055/s-0038-1653962
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Off-Pump Coronary Artery Bypass Graft Versus Drug-Eluting Stent Implantation in Patients with Multivessel Disease Involving the Right Coronary Artery

Jun Ho Lee
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
,
Dong Seop Jeong
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
,
Kiick Sung
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
,
Wook Sung Kim
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
,
Pyo Won Park
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
,
Hyuck Kim
2  Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, The Republic of Korea
,
K. C. Carriere
3  Department of Mathematical and Statistical Sciences, Samsung Medical Center, Gangnam-gu, Seoul, The Republic of Korea
,
Young Tak Lee
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Gangnam-gu, The Republic of Korea
› Author Affiliations
Further Information

Publication History

16 January 2018

10 April 2018

Publication Date:
29 May 2018 (online)

Abstract

Background Whether percutaneous coronary intervention (PCI) is superior to coronary artery bypass grafting (CABG) for the right coronary territory is unknown. The aim of this study was to compare the outcomes and patency in the right coronary territory after CABG or PCI.

Methods We studied 2,467 multivessel coronary artery disease patients from January 2001 to December 2011; 1,672 were off-pump CABG patients and 795 were PCI. The graft patency and the presence of major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, target vessel revascularization, and stroke were analyzed.

Results After propensity score matching, cardiac-related survival was found to be significantly higher in the CABG group than in the PCI group (hazard ratio (HR) for the PCI group: 2.445, p = 0.006). The PCI group showed higher rates of myocardial infarction (HR: 2.571, p = 0.011) and target vessel revascularization (HR: 3.337, p < 0.001). In the right coronary territory, the right internal thoracic artery patency was not different in the PCI group compared with the CABG group (p = 0.248). In CABG group, low right coronary artery graft patency was associated with cardiac-related death (HR: 0.17, p = 0.003) and the occurrence of MACCEs (HR: 0.22, p < 0.001).

Conclusion CABG was superior to PCI in patients with multivessel disease. Low graft patency in the right coronary territory was associated with cardiac-related death and the occurrence of MACCEs.

Supplementary Material