• J. Thorac. Cardiovasc. Surg. · Oct 2020

    Comparative Study Observational Study

    Outcomes of different revascularization strategies among patients presenting with acute coronary syndromes without ST elevation.

    • Eilon Ram, Leonid Sternik, Robert Klempfner, Zaza Iakobishvili, Yael Peled, Nir Shlomo, and Ehud Raanani.
    • Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel. Electronic address: eilon.ram@sheba.health.gov.il.
    • J. Thorac. Cardiovasc. Surg. 2020 Oct 1; 160 (4): 926-935.e6.

    ObjectiveTo compare short- and long-term outcomes of patients hospitalized with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA) who were referred for revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in a real-world national cohort.MethodsThis observational study included 5112 patients, who underwent either CABG or PCI, admitted for NSTEMI or UA and were enrolled in the Acute Coronary Syndrome Israeli Survey between 2000 and 2016. Propensity score-matching analysis compared early outcomes and all-cause mortality in patients who underwent revascularization by PCI with revascularization by CABG.ResultsOf the 5112 patients, 4327 (85%) underwent PCI and 785 (15%) CABG. Following propensity score analysis, 447 pairs were chosen (1:1). Independent predictors for CABG referral included 3-vessel CAD (odds ratio [OR], 5.5; 95% confidence interval [CI], 4.5-6.7, P < .001), absence of on-site cardiac surgery (OR, 1.3; 95% CI, 1.1-1.6, P = .004), no previous PCI (OR, 1.5; 95% CI, 1.2-1.9, P = .002) and no previous myocardial infarction (OR, 1.3; 95% CI, 1-1.7, P = .022). The 10-year mortality risk was significantly lower among those who underwent CABG compared with PCI (20.4% vs 28.4%, P = .006). Consistent with these findings, multivariable analysis showed that referral to CABG was independently associated with a significant 65% reduction in the risk of 10-year mortality (P < .001). This long-term advantage was seen among male patients (P < .001) and not female patients (P = .910).ConclusionsIn a real-life setting, revascularization by CABG provides excellent long-term outcomes in patients with NSTEMI or UA. The advantage of CABG over PCI was seen only in male patients.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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