Comparison of Clinical Outcomes in Patients Who Underwent Bare Metal Coronary Stenting Versus Coronary By-pass Surgery

Introduction: We aimed to compare the effects of coronary lesion complexity assessed by SYNTAX (Sx) score on the clinical outcomes in patients who have received BMS versus undergone coronary bypass grafting. Patients and Methods: Our study population consisted of 459 consecutive patients received bare metal stents (n= 265) or coronary bypass grafting (n= 294). The complexity of coronary artery disease was assessed by Sx score. Sx score was classifi ed as tertiles, as follows: low Sx score (≤ 22), intermediate Sx score (23-32) and high Sx score (≥ 33). Results: Throughout the study, the intermediate-term incidence of any revascularization was signifi cantly higher in the percutaneous coronary intervention group compared with the coronary bypass grafting group for both overall group and Sx tertiles. The intermediate-term incidence of death from any cause was comparable between the treatment groups in patients with low and intermediate Sx tertiles. However, in patients with high Sx tertile, the intermediate-term incidence of death from any cause was signifi cantly higher in percutaneous coronary intervention group compared with coronary bypass grafting group. In the overall population, adjusted [hazard ratio, 95% CI: 0.88 (0.38-2.05), p= 0.780) risks for death from any cause were consistently comparable between percutaneous coronary intervention and coronary bypass grafting, whereas adjusted [hazard ratio, 95% CI: 0.12 (0.05-0.30), p< 0.001] risks for any revascularization were consistently signifi cantly higher in the percutaneous coronary intervention group compared with coronary bypass grafting group. Yazışma Adresi/ Correspondence Dr. İbrahim Halil Tanboğa Atatürk Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı Erzurum-Türkiye e-posta haliltanboga@atauni.edu. tr ORİJİNAL ARAŞTIRMA • ORIGINAL INVESTIGATION Kosuyolu Kalp Derg 2013;16(2):99-106 ● doi: 10.5578/kkd.4696 Comparison of Clinical Outcomes in Patients Who Underwent Bare Metal Coronary Stenting Versus Coronary By-pass Surgery Koroner Baypas Cerrahisi ve Çıplak Metal Stent Uygulanan Hastaların Klinik Sonlanımlarının Karşılaştırılması Kosuyolu Kalp Derg 2013;16(2):99-106 100 INTRODUCTION Contemporary treatment guidelines recommend coronary artery bypass grafting (CABG) as the treatment of choice for patients with a complex coronary artery disease (CAD), such as multi vessel disease or left main coronary disease(1,2). However, recent improvements in revascularization technology, especially in areas involving drug eluting stents (DES) and operation techniques, increase the role of revascularization in the management of complex CAD(3-5). A better understanding of coronary lesion anatomy and the development of percutaneous and surgical techniques, accordingly, lead to the improvement of longterm morbidity and mortality of complex CAD(1,2). In the last decade, many randomized controlled trials, comparing CABG versus percutaneous coronary intervention (PCI) using bare metal stents (BMS) or DES for long-term prognosis of CAD, were conducted. Long-term outcome studies comparing CABG versus PCI using both BMS and DES revealed that there were no signifi cant differences regarding death or composite death, stroke and myocardial infarction, higher incidence of any revascularization in PCI (both DES and BMS) versus CABG were observed clearly(6-11). After SYNTAX (Sx-Synergy between Taxus and Cardiac Surgery) trial, in many comparative studies, almost all of them DES versus CABG studies, long-term outcome, based on coronary lesions anatomy by Sx score, were studied(12-16). However, there is no study related to how coronary anatomy assessed by Sx score affects the clinical outcomes in patients who have undergone CABG or who have received BMS. Therefore, in this study, we aimed to investigate the relation of coronary anatomy assessed by Sx score with intermediate-term adverse outcomes in patients who underwent PCI using BMS or CABG. PATIENTS and METHODS Study Population From March 2009 to August 2010, 559 consecutive patients undergoing PCI using BMS (n= 265) or CABG (n= 294) in our hospital were enrolled in our study, retrospectively. Patients who had prior history of CABG and PCI, those who underwent concomitant valvular surgery, who had ST-segment elevation myocardial infarction, those who underwent to emergent CABG due to PCI complication or who were treated with cardiogenic shock were excluded Conclusion: Coronary lesion complexity assessed by SYNTAX score was closely associated with the higher incidence of any revascularization and in high SYNTAX score, with higher incidence of death from any cause in patients received bare metal stents than coronary artery bypass grafting.