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Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation

 Sung-Jin Hong  ;  Byeong-Keuk Kim  ;  Sanghoon Shin  ;  Yongsung Suh  ;  Seunghwan Kim  ;  Chul-Min Ahn  ;  Jung-Sun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang 
 Circulation Journal, Vol.82(4) : 1092-1100, 2018 
Journal Title
 Circulation Journal 
Issue Date
Coronary artery bypass graft ; Percutaneous coronary intervention
BACKGROUND: The long-term outcome of percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG), particularly for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), remains controversial.Methods and Results:We retrospectively analyzed 2,827 patients (stable coronary artery disease [SCAD], n=1,601; NSTE-ACS, n=1,226) who underwent either PCI (n=1,732) or CABG (n=1,095). The 8-year composite of cardiac death and myocardial infarction (MI) was compared between PCI and CABG before and after propensity matching. For patients with NSTE-ACS, PCI was performed more frequently for those with higher Thrombolysis in Myocardial Infarction risk score and 3-vessel disease, and PCI led to significantly higher 8-year composite of cardiac death and MI than CABG (14.1% vs. 5.9%, hazard ratio [HR]=2.22, 95% confidence interval [CI]=1.37-3.58, P=0.001). There was a significant interaction between clinical presentation and revascularization strategy (P-interaction=0.001). However, after matching, the benefit of CABG vs. PCI was attenuated in patients with NSTE-ACS, whereas it was pronounced in those with SCAD. Interactions between clinical presentation and revascularization strategy were not observed (P-interaction=0.574). CONCLUSIONS: Although the determinants of PCI vs. CABG in real-world clinical practice differ according to the clinical presentation, a significant interaction between clinical presentation and revascularization strategy was not noted for long-term outcomes. The revascularization strategy for patients with NSTE-ACS can be based on the criteria applied to patients with SCAD.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
고영국(Ko, Young Guk) ORCID logo https://orcid.org/0000-0001-7748-5788
김병극(Kim, Byeong Keuk) ORCID logo https://orcid.org/0000-0003-2493-066X
김중선(Kim, Jung Sun) ORCID logo https://orcid.org/0000-0003-2263-3274
안철민(Ahn, Chul-Min) ORCID logo https://orcid.org/0000-0002-7071-4370
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
홍명기(Hong, Myeong Ki) ORCID logo https://orcid.org/0000-0002-2090-2031
홍성진(Hong, Sung Jin) ORCID logo https://orcid.org/0000-0003-4893-039X
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