Evidence-Based Optimal Myocardial Revascularization : Perspective from the CREDO-Kyoto Registry / 日本心臓血管外科学会雑誌

ABSTRACT

Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. Among the 9,877 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI using bare-metal stents and CABG patients in Japan), 6,327 patients with multivessel and/or left main disease were enrolled in the present study (PCI 3,877/CABG 2,450). Median follow-up was 3.5 years. Propensity-score-adjusted all-cause mortality after PCI was higher than that of CABG (hazard ratio [95% confidence interval] : 1.37 [1.15-1.63], <i>p</i>< 0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 [0.59-0.96], <i>p</i>=0.02). The predicted risk of operative mortality (PROM) of each patient of on-pump/off-pump CABG was calculated by the logistic EuroSCORE. Patients were divided into tertiles based on their PROM. The hazard ratio of the incidence of stroke in on-pump CABG compared with off-pump CABG in the high-risk tertile was 1.80 ([1.07-3.02], <i>p</i>=0.03). The adjusted overall mortality was not significantly different between the two procedures even in the high-risk tertile (1.44 [0.98-2.11], <i>p</i>=0.06). In patients with multivessel and/or left main disease, CABG was associated with better survival outcomes than PCI using bare-metal stents. Off-pump CABG as opposed to on-pump CABG is associated with short-and long-term benefits in stroke prevention in patients with higher risk as evaluated by the EuroSCORE. No survival benefit of OPCAB was shown, regardless of preoperative risk level.