Background: Young patients with coronary artery disease are undergoing percutaneous coronary intervention (PCI) primarily, with a view to deferring coronary artery bypass grafting (CABG). We investigated the validity of this approach, by comparing outcomes in patients ≤50 years undergoing CABG or PCI.
Methods:One hundred consecutive patients undergoing PCI and 100 undergoing CABG in 2004 were retrospectively studied to allow for 5 and 12 years follow-up.The two groups were compared for the primary endpoints of major adverse cardiac or cerebrovascular event (MACCE).Results: Diabetes, peripheral vascular disease, and left ventricular ejection fraction <50% were higher in the CABG group. At 5 years, rates of myocardial infarction (MI) (9% vs 1%, P = .02), repeat revascularization (31% vs 7%, P < .01), and MACCE (34 vs 12, P < .01) were greater in the PCI vs the CABG group. Similarly, at 12 years, rates of MI (27.4% vs 19.4%, P = .19), repeat revascularization (41.1% vs 20.4%, P < .01), and MACCE (51 vs 40, P = .07) were greater in the PCI group. There were no differences in major outcomes in patients with 1 or 2VD, at 5 or 12 years. Rates of MI, revascularization, and MACCE were higher in patients with 3VD undergoing PCI (n = 21; MI, 47.6%; revascularization, 66.7%; and MACCE, 19 events) vs CABG (n = 78; MI, 19.2%; revascularization, 20.5%; and MACCE, 31 events); P < .01, for all end points.Conclusions: MACCE was lower in young patients undergoing CABG vs PCI at both 5 and 12 years follow-up, primarily as a consequence of patients with 3VD undergoing PCI having more MI and repeat revascularization. CABG should remain the preferred method of revascularization in young patients with 3VD.
K E Y W O R D Scoronary artery disease, coronary artery disease in the young, revascularization Abbreviations: BMS, bare metal stent; CABG, coronary artery bypass graft; CAD, coronary artery disease; DES, drug-eluting stent; IABP, intra-aortic balloon pump; IMA, internal mammary artery; LAD, left anterior descending artery; LIMA, left internal mammary artery; LMS, left main stem; LVF, left ventricular function; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac or cerebrovascular event, includes death from any cause, stroke, myocardial infarction or repeat revascularization; MI, myocardial infarction; PATS, Patient Administration and Tracking System; PCI, percutaneous coronary intervention; VD, vessel disease.