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Long-term survival advantage of OPCAB over PCI with 1st generation DES in triple vessel coronary artery disease
Gijong Yi, Hyun-Chel Joo, Young-Nam Youn, Kyung-Jong Yoo.
Yonsei University Gangnam Severance Hospital, Seoul, Korea, Republic of.

Objective
Recently published large volume randomized trials and registry data showed survival advantage of surgical coronary revascularization compared to percutaneous coronary intervention (PCI) after long-term follow-up. We evaluated long-term survival between off-pump surgical revascularization (OPCAB) and PCI with 1st generation DES to assess whether there is a survival advantage in the surgery group.
Methods
From 2003 to 2008, 2498 patients underwent OPCAB or PCI with DES as their initial revascularization therapy (OPCAB group (n=981) vs PCI group (n=1517)). Emergency and life-saving procedures were excluded. Study end-points were all-cause mortality and major adverse cardiac and cerebrovascular event (MACCE). Mean follow-up duration was 6.7 years and follow-up rate was 97.4%. We evaluated real-world comparison (N=2498) and propensity score matched population comparison (N=1436).
Results
Early mortality was comparable between the two groups. In real-world comparison, overall survival at 10 years was 86.2±2.1% in the OPCAB group and 81.7±1.1% in the PCI group (p<0.001). Freedom from MACCE rates were 77.5±1.7% in the OPCAB group and 60.7±1.5% in the PCI group at 10 years (p<0.001). In the propensity score matched population, 10-year survival rates were 79.7 ±2.5% in the OPCAB group and 74.2 ±2.0% in the PCI group (p=0.001). 10-year freedom from MACCE rate was better in the OPCAB group (66.4 ±2.9 vs 46.7 ± 3.8%, p<0.001) and the determining factors were all-cause mortality (p=0.001), nonfatal MI (p=0.005) and target vessel revascularization (p<0.001).
Conclusions
The OPCAB showed better overall survival compared to 1st generation DES after a mean of 6.7 years follow-up. Freedom from MACCE rate was better in the OPCAB group mainly due to the lower incidence of mortality, nonfatal MI and target vessel revascularization.


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