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Composite risk lower after CABG compared with PCI

Friday February 22, 2013
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Patients who undergo coronary artery bypass grafting surgery have a lower overall composite risk for myocardial infarction, stroke and death in the four years following the procedure compared with patients who undergo percutaneous catheter intervention procedures, according to a study.

The findings are from phase 2 of the American College of Cardiology Foundation/Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) study — the largest trial to date comparing CABG outcomes to outcomes from PCI, according to a news release.

Fred H. Edwards, MD, emeritus professor of surgery at the University of Florida, Jacksonville, and colleagues analyzed data from nearly 190,000 Medicare patients to compare long-term outcomes from CABG and PCI. In this study, 94% of PCI patients had stent placement and 6% had balloon angioplasty.

"ASCERT showed that in the first few months after the procedure, results favored PCI, but long-term data demonstrated a clear overall advantage for CABG," Edwards, also director of the Society of Thoracic Surgeons Research Center, said in a news release. "The benefits of CABG progressively increase over time, demonstrating the long-term durability of the procedure."

Phase 1 of ASCERT showed that patients who underwent CABG were 21% less likely to die four years after surgery than patients who had PCI. The follow-up study, which was scheduled for presentation Jan. 29 in Los Angeles at the Society of Thoracic Surgeonsí annual meeting, looked at the composite outcomes of MI, stroke and death

Collaborating investigators from STS and the ACC used CABG data from the STS National Database and PCI data from the ACC National Cardiovascular Data Registry for patients age 65 and older who underwent revascularization from 2004 through 2007. These data were then linked to information from the Centers for Medicare & Medicaid Services for follow up through 2008.

The researchers found that more than four years following the procedure, CABG patients had a lower risk of MI. PCI patients had a lower risk of stroke, primarily because of a higher stroke incidence in the first 30 days after CABG treatment. CABG patients had a 19% lower risk of suffering a composite outcome of stroke, MI and/or death.


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