STS: Fewer strokes with PCI but CABG advantage persists

Researchers conducting an analysis of the long-term outcomes for Medicare patients with multivessel disease found that PCI had a lower incidence of stroke between one and four years post-procedure, but CABG had lower risks of MI and of a composite of stroke, MI and death. These results were presented Jan. 29 at the Society for Thoracic Surgeons meeting in Los Angeles.

Fred H. Edwards, MD, of the University of Florida in Jacksonville, and colleagues examined the records of participants in the ASCERT (ACCF-STS Database Collaboration on the Comparative Effectiveness of Revascularization Strategies) trial. The cohort included 86,244 patients who underwent CABG and 103,549 who underwent PCI between 2004 and 2007. All the patients were 65 years old or older.

By linking to Centers for Medicare & Medicaid Services (CMS) data, the researchers were able to access information about long-term outcomes. They used propensity scoring and inverse probability weighting to create CABG and PCI groups with similar clinical characteristics and compared long-term outcomes and temporal trends for each group. Outcomes of interest were stroke, MI, death and a composite of stroke, MI and death.

At one year post-procedure, PCI patients experienced fewer events than CABG patients; however, at two years, CABG patients experienced fewer events, and the advantage for CABG increased with each successive year. At four years, 21.6 percent of CABG patients had experienced an event compared with 26.7 percent of PCI patients.

Four years post-procedure, CABG patients experienced MI at a rate of 3.2 percent compared to 6.6 percent among PCI patients. But PCI patients had the advantage with stroke: at four years out, 4.5 percent of CABG patients had experienced stroke, compared with 3.2 percent of PCI patients.

A previous analysis of the ASCERT data had demonstrated that CABG patients had a 21 percent lower risk-adjusted mortality after four years compared to PCI patients. The current study was the first to assess the comparative risk of MI and stroke in the study population.