CABG Preferred Over PCI in Patients with Triple Vessel Disease

A new study shows that percutaneous coronary intervention (PCI) is associated with significantly higher risk for serious adverse events in patients with triple vessel disease, when compared to coronary artery bypass grafting (CABG).

Researchers at Kyoto University Hospital (Japan) conducted a physician-initiated study involving 2,981 consecutive patients with triple vessel disease--PCI 1,825 patients, and CABG 1,156 patients-- that underwent coronary revascularization between January 2005 and December 2007. To ensure comparability between the PCI and CABG groups, anatomic complexities of coronary artery disease (CAD) were assessed by using the SYNTAX score. The primary endpoint of the study was a composite of all-cause death, myocardial infarction (MI), and stroke.

The results showed that PCI was associated with a higher 3-year risk for the primary composite endpoint, and the risk for all-cause death was also significantly higher after PCI. The risk for cardiac death, however, was not significantly different. The results also showed that the cumulative incidence of the primary endpoint was comparable between the PCI and CABG groups in patients with low and intermediate SYNTAX scores, but in patients with high SYNTAX scores was markedly higher after PCI than after CABG. The study was presented at the annual European Society of Cardiology (ESC) congress, held during August 2011 in Paris (France).

“CABG would still remain the standard treatment option in patients with triple vessel disease, particularly when their SYNTAX scores are high,” said lead author and study presenter Hiroki Shiomi, MD, of the division of cardiology. “Further studies are therefore warranted to investigate whether PCI is a viable option in patients with less complex coronary anatomy.”

The findings are at odds with recently published three-year results from the pivotal randomized Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, in which CABG emerged as the preferred strategy at three years for both the high-risk tertile (SYNTAX score >33) and moderate-risk tertile (SYNTAX score 23-32), whereas in the lowest-risk group (SYNTAX score <23) both PCI and CABG yielded similar outcomes.

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Kyoto University Hospital