Single or Multiple Arterial CABG vs. PCI in 3VD or Left Main
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The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG).

The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ?10?years of follow-up.

The primary endpoint was all-cause mortality at maximum follow-up (median 11.9?years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively. Multiple arterial grafting, but not SAG, was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG and SAG were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG or SAG were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival.

Conclusively, these findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD.

Source: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab537/6354120
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