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Multiple Arterial Grafts Improve Early MACCE Rate Compared with Conventional CABG and PCI
Chaim Locker, MD, Richard C Daly, MD, Joseph A Dearani, MD, Hartzell V Schaff, MD.
Mayo Clinic, Rochester, MN, USA.

OBJECTIVE: We aimed to compare in-hospital and 30-day (early) major adverse cardiac and cerebrovascular event (MACCE) rate including death, stroke, myocardial infarction (MI), and repeat revascularization (RR), in patients with multivessel disease undergoing multi arterial (MultArt) coronary artery bypass grafting (CABG), with LIMA/saphenous veins (LIMA/SV) or with percutaneous coronary intervention (PCI). There is no data in literature comparing the early MACCE rate of these 3 revascularization strategies.
METHODS: From January 1, 1993 through December 31, 2009, 12,615 consecutive patients underwent isolated primary CABG (n=6,667) with LIMA/SV (n=5,712) or with MultArt (n=955), or were treated by PCI (n=5,948) with balloon angioplasty (BA; n=1,020), bare metal stent (BMS; n=3,242), and drug-eluting stent (DES; n=1,686). We excluded patients with acute MI. We propensity- score matched the overall CABG group with each of the 3 PCI subgroups, and the overall PCI group with each of the 2 CABG subgroups. Multivariable logistic regression models were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE.
RESULTS: Unadjusted MACCE was lower for MultArt (1.5%) than LIMA/SV (4.5%, P<0.001)) and PCI (8.5%, P<0.001). In matched analysis, CABG had lower MACCE rate vs BA (4.7% vs 13.2%, [P<0.001]), BMS (4.3% vs 8.3%, [P<0.001]), and DES (2.9% vs 5.5%, [P=0.008]), as well as LIMA/SV vs PCI (4.6% vs 9.2%, [P<0.001]) and MultArt vs PCI (1.8% vs 7.8%, [P<0.001]). Stroke rate was not significantly different in matched patients treated with MultArt vs PCI (0.8% vs 0.3%, P=0.18) but significantly higher in matched patients undergoing LIMA/SV vs PCI (2.3% vs 0.4%, [P<0.001]) (See Figure). In multivariate analysis, PCI (Odds ratio (OR), 4.53; 95% confidence interval [CI], 2.62-7.83; P<0.001) and LIMA/SV, (OR, 2.04; 95% CI, 1.18-3.53; P<0.011), were both strong predictors of MACCE compared with MultArt.
CONCLUSIONS: Among patients with multi vessel disease who underwent coronary revascularization during the last 20 years, MultArt revascularization conferred lower early MACCE rate compared with PCI and conventional CABG. Our results strongly recommend on marked increase in utilization of MultArt. In future studies comparing PCI and CABG, MultArt should be the standard for surgical revascularization.

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Endorsed by:
The Society of Thoracic Surgeons

Co-sponsored by:
Association of Physician Assistants in Cardiovascular Surgery (APACVS) The International Society for Minimally Invasive Cardiothoracic Surgery Japanese Association for Coronary Artery Surgery
Brazilian Society of Cardiovascular Surgery Fu-Wai Hospital of Beijing Indian Association of Cardiovascular-Thoracic Surgeons
Society for Cardiothoracic Surgery in Great Britain & Ireland