Clinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: Insights from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventional Group (MIG) Registries

Yan, Bryan P.; Clark, David J.; Buxton, Brian; Ajani, Andrew E.; Smith, Julian A.; Duffy, Stephen J.; Shardey, Gil C.; Skillington, Peter D.; Farouque, Omar; Yii, Michael; Yap, Cheng-Hon; Andrianopoulos, Nick; Brennan, Angela; Dinh, Diem; Reid, Christopher M.; on behalf of the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS), the Melbourne Interventional Group (MIG),

doi:10.1016/j.hlc.2008.10.005

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Volume 18, Issue 3 , Pages 184-190, June 2009

Clinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: Insights from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventional Group (MIG) Registries

Bryan P. Yan, MBBS
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
David J. Clark, MBBS
- Departments of Cardiology, Austin, Australia
Brian Buxton, MBBS
- Department of Cardiothoracic Surgery, Austin, Australia
Andrew E. Ajani, MBBS, MD
- Departments of Cardiology, Royal Melbourne, Australia
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Monash University, Australia
- University of Melbourne, Melbourne, Victoria, Australia
Julian A. Smith, MBBS
- Department of Cardiothoracic Surgery, Monash Medical Centre, Australia
Stephen J. Duffy, MBBS, PhD
- Departments of Cardiology, Alfred Hospitals, Australia
Gil C. Shardey, MBBS
- Department of Cardiothoracic Surgery, Monash Medical Centre, Australia
Peter D. Skillington, MBBS
- Department of Cardiothoracic Surgery, Royal Melbourne, Australia
Omar Farouque, MBBS, PhD
- Departments of Cardiology, Austin, Australia
Michael Yii, MBBS, MS
- Department of Cardiothoracic Surgery, St. Vincent Hospitals, Victoria, Australia
Cheng-Hon Yap, MBBS, MS
- Department of Cardiothoracic Surgery, Royal Melbourne, Australia
Nick Andrianopoulos, MBBS
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Monash University, Australia
Angela Brennan, RN
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Monash University, Australia
Diem Dinh
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Monash University, Australia
Christopher M. Reid, PhD
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Monash University, Australia
- Corresponding author at: NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University Commercial Road, Melbourne, VIC 3004, Australia. Tel.: +61 3 9903 0517.
on behalf of the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS), the Melbourne Interventional Group (MIG)

Received 29 July 2008; accepted 3 October 2008.

Objectives

Controversy continues over the optimal revascularisation strategy for patients with multi-vessel coronary artery disease. Clinical characteristics, risk profile, and mortality of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are thought to differ but there are limited contemporary comparative data.

Methods

We compared clinical characteristics, in-hospital and 30-day mortality of 3841 consecutive patients undergoing isolated CABG and 4417 undergoing PCI. Independent predictors of 30-day mortality were determined by multiple logistic regression analysis.

Results

CABG patients were older (p<0.01). The CABG group had a higher incidence of diabetes, heart failure, left ventricular ejection fraction <45%, multi-vessel coronary artery, peripheral vascular and cerebro-vascular disease (all p<0.01). Patients undergoing PCI had a higher incidence of recent myocardial infarction (MI) as the indication for revascularisation (p<0.01). In-hospital and 30-day mortality was 1.8% and 1.7% in the CABG group, and 1.4% and 1.8% in the PCI group, respectively. Independent predictors of 30-day mortality after CABG were age (odds ratio 1.1 per year, 95% confidence interval 1.0–1.1), cardiogenic shock (4.10, 1.7–10.5) and previous CABG (6.6, 2.4–17.7). Predictors after PCI were diabetes (2.7, 1.4–5.1), female gender (3.0, 1.6–5.5), renal failure (3.2, 1.2–8.0), MI<24h (4.0, 2.2–7.6), left main intervention (5.4, 1.0–27.7), heart failure (6.0, 2.6–14.0) and cardiogenic shock (11.7, 5.4–25.2).

Conclusions

In contemporary clinical practice, CABG is preferred in patients with multi-vessel coronary and associated non-coronary vascular disease, while PCI is the dominant strategy for acute MI. Despite this, in-hospital and 30-day mortality rates were similar. Predictors of early mortality after CABG differ to those of PCI.

Keywords: Coronary artery bypass surgery, Percutaneous coronary intervention