Off-Pump Coronary Artery Bypass Graft Versus Drug-Eluting Stent Implantation in Patients with Multivessel Disease Involving the Right Coronary Artery
16 January 2018
10 April 2018
29 May 2018 (online)
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.
Keywordscoronary artery bypass grafting - percutaneous coronary intervention - right coronary artery
- 1 Serruys PW, Ong AT, van Herwerden LA. , et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol 2005; 46 (04) 575-581
- 2 Hueb W, Lopes NH, Gersh BJ. , et al. Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation 2007; 115 (09) 1082-1089
- 3 Booth J, Clayton T, Pepper J. , et al; SoS Investigators. Randomized, controlled trial of coronary artery bypass surgery versus percutaneous coronary intervention in patients with multivessel coronary artery disease: six-year follow-up from the Stent or Surgery Trial (SoS). Circulation 2008; 118 (04) 381-388
- 4 Kapur A, Hall RJ, Malik IS. , et al. Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol 2010; 55 (05) 432-440
- 5 Mohr FW, Morice MC, Kappetein AP. , et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867): 629-638
- 6 Buxton BF, Hayward PA, Newcomb AE, Moten S, Seevanayagam S, Gordon I. Choice of conduits for coronary artery bypass grafting: craft or science?. Eur J Cardiothorac Surg 2009; 35 (04) 658-670
- 7 Maniar HS, Sundt TM, Barner HB. , et al. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 2002; 123 (01) 45-52
- 8 Gan HL, Zhang JQ, Huang F. , et al. Prognosis of percutaneous coronary intervention and coronary artery bypass grafts for ostial right coronary lesions in propensity-matched individuals. Cardiovasc Ther 2011; 29 (06) 395-403
- 9 Jeong DS, Kim YH, Lee YT. , et al. Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery. Ann Thorac Surg 2013; 96 (03) 778-785 , discussion 785
- 10 Jeong DS, Lee HY, Min HK. , et al. Graft selection for the right coronary artery territory in off-pump coronary artery bypass. Thorac Cardiovasc Surg 2012; 60 (07) 432-437
- 11 Pevni D, Uretzky G, Yosef P. , et al. Revascularization of the right coronary artery in bilateral internal thoracic artery grafting. Ann Thorac Surg 2005; 79 (02) 564-569
- 12 Kim WS, Lee J, Lee YT. , et al. Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique. Ann Thorac Surg 2008; 86 (06) 1861-1865
- 13 Li Z, Denton T, Yeo KK. , et al. Off-pump bypass surgery and postoperative stroke: California coronary bypass outcomes reporting program. Ann Thorac Surg 2010; 90 (03) 753-759
- 14 Hannan EL, Wu C, Smith CR. , et al. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation 2007; 116 (10) 1145-1152
- 15 Demaria RG, Carrier M, Fortier S. , et al. Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation 2002; 106 (12) (Suppl. 01) I5-I10
- 16 Vallely MP, Potger K, McMillan D. , et al. Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery. Heart Lung Circ 2008; 17 (04) 299-304
- 17 Lev-Ran O, Loberman D, Matsa M. , et al. Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann Thorac Surg 2004; 77 (01) 102-107
- 18 Borger MA, Rao V, Weisel RD. , et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998; 65 (04) 1050-1056
- 19 Jeong DS, Sung K, Lee YT. , et al. Pure bilateral internal thoracic artery grafting in diabetic patients with triple-vessel disease. Ann Thorac Surg 2015; 100 (06) 2190-2197
- 20 Cho KR, Kim JS, Choi JS, Kim KB. Serial angiographic follow-up of grafts one year and five years after coronary artery bypass surgery. Eur J Cardiothorac Surg 2006; 29 (04) 511-516
- 21 Hannan EL, Wu C, Walford G. , et al. Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv 2009; 2 (01) 17-25