Survival difference between coronary bypass surgery and percutaneous coronary intervention

Figures & data

Table I. Baseline demographic and clinical variables.

Variable	1999–2005 PCI N = 6749	2006–2011 PCI N = 5669	1999–2005 CABG N = 3926	2006–2011 CABG N = 1395	P value
Age years (mean ± SD)	63.8 ± 11.0	66.0 ± 10.9	66.9 ± 9.9	67.1 ± 9.6	< 0.001
Gender (male/female) %	73.3/26.7	71.8/28.2	77.5/22.5	77.0/23.0	< 0.001
Ejection fraction % (mean ± SD)	67.7 ± 13.2	67.6 ± 11.4	67.3 ± 13.7	67.8 ± 11.8	0.6
LVEDP mmHg (mean ± SD)	13.4 ± 4.9	15.0 ± 4.7	14.2 ± 5.6	16.2 ± 5.5	< 0.001
Generalized arteriosclerosis %	2.8	5.7	3.9	1.4	< 0.001
Other significant disease %	2.6	8.7	2.7	6.2	< 0.001
Ischemia on EECG %	32.7	19.7	48.5	32.8	< 0.001
CCS function class %
0	2.1	0.9	1.9	1.3
I	7.9	3.9	5.3	4.0
II	34.3	34.4	31.3	26.8
III	38.0	46.3	46.2	52.3
IV	17.7	14.6	15.3	15.7	< 0.001
Unstable angina %	26.0	29.5	25.9	30.2	< 0.001
Diabetes %	11.5	14.2	14.8	16.0	< 0.001
Hypertension %	28.3	33.5	34.4	34.1	< 0.001
Current smoker %	25.9	16.5	22.1	14.4	< 0.001
Previous myocardial infarction %	48.4	28.0	47.8	28.5	< 0.001
Previous PCI %	15.0	18.9	6.6	10.5	< 0.001
Previous CABG %	14.1	13.2	2.7	1.7	< 0.001
Radial entry site %	85.1	78.8	85.4	61.5	< 0.001
Coronary angiography
One-vessel disease %	42.6	48.8	1.9	2.0
Two-vessel disease %	30.8	29.5	15.7	18.5
Three-vessel disease %	26.6	21.7	82.4	79.5	< 0.001

LVEDP, left ventricular end diastolic pressure. Generalized arteriosclerosis is defined as “previous extra-cardiac arteriosclerotic symptoms.” EECG, exercise ECG. CCS, Canadian Cardiovascular Society functional class for angina. Diabetes is defined as “previously known and treated diabetes with diet or drugs.” Other significant disease is defined as “renal, hepatic, or pulmonary disease and serious obesity deemed of importance in the treatment at the discretion of the physician.” Unstable angina also includes patients with non-ST-elevation myocardial infarction.

Figure 1. Kaplan–Meier estimate of mortality with significant difference between the four groups (p < 0.001—log-rank test).

Table II. The complete multivariable model.

Variable	Hazard ratio	95% CI	p value
Age (/10 year)*	2.26	2.14–2.41	< 0.001
Ejection fraction (/5%)*	0.87	0.85–0.88	< 0.001
Gender	1.23	1.09–1.38	< 0.001
Smoking	1.39	1.22–1.57	< 0.001
Diabetes	1.39	1.22–1.57	< 0.001
Ischemia on exercise ECG	0.71	0.63–0.81	< 0.001
CCS function class	1.25	1.17–1.34	< 0.001
Number of diseased coronary arteries	1.38	1.26–1.51	< 0.001
Generalized arteriosclerosis	1.26	1.03–1.53	0.022
Other significant disease	2.57	2.17–3.04	< 0.001
Interaction number of diseased vessels and strategy/epoch	0.85	0.77–0.93	0.001
PCI 1999–2005	Reference value = 1
PCI 2006–2011	1.05	0.89–1.24	0.565
CABG 1999–2005	1.20	0.85–1.70	0.294
CABG 2006–2011	1.20	0.71–2.05	0.50

*The hazard ratios are calculated for each 10-year increment in age and 5% increment in ejection fraction, respectively.

Table III. Comparison across strategy/time periods and number of diseased vessels calculated from the multivariable Cox model.

Strategy/time period	One-vessel disease		Two-vessel disease		Three-vessel disease
	HR (95% CI)	p value	HR (95% CI)	p value	HR (95% CI)	p value
PCI 1999–2005	Reference cohort
CABG 1999–2005	1.20 (0.85–1.20)	0.294	0.86 (0.72–1.03)	0.110	0.62 (0.53–0.71)	< 0.001
PCI 2006–2011	Reference cohort
CABG 2006–2011	1.14 (0.74–1.77)	0.553	0.82 (0.61–1.06)	0.179	0.59 (0.47–0.73)	< 0.001

Table IV. Comparison across strategy/time periods and number of diseased vessels calculated from the Cox model with propensity score as single covariate.

Strategy/time period	One-vessel disease (N = 5165)		Two-vessel disease (N = 4285)		Three-vessel disease (N = 7011)
	HR (95% CI)	p value	HR (95% CI)	p value	HR (95% CI)	p value
PCI 1999–2005	Reference cohort
CABG 1999–2005	1.61 (0.71–3.63)	0.254	1.00 (0.72–1.37)	0.979	0.64 (0.54–0.76)	< 0.001
PCI 2006–2011	Reference cohort
CABG 2006–2011	0.53 (0.07–3.79)	0.526	0.57 (0.32–1.02)	0.059	0.46 (0.35–0.61)	< 0.001