# Ten-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with three-vessel disease and heart failure

## TL;DR

Coronary artery bypass grafting (CABG) provides better long-term survival and fewer heart-related complications than PCI in patients with three-vessel disease and heart failure.

## Contribution

This study provides the first long-term observational evidence comparing CABG and PCI outcomes in patients with three-vessel disease and heart failure.

## Key findings

- CABG was associated with significantly lower 10-year mortality compared to PCI.
- CABG reduced readmissions for myocardial infarction and repeat revascularization.
- Stroke and rehospitalization rates were not significantly different between the two groups.

## Abstract

The optimal revascularization strategy for patients with three-vessel coronary artery disease (3VD) and heart failure (HF) remains uncertain due to the absence of randomized trials directly comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). With few observational studies providing long-term follow-up, clinical equipoise persists. We therefore evaluated 10-year outcomes between CABG and PCI in patients with HF and 3VD.

This retrospective population-based cohort study included adults with 3VD and HF undergoing isolated CABG or PCI in Edmonton, Alberta, Canada (2009–2018). Patients with STEMI, prior CABG, or concomitant procedures were excluded. The primary endpoint was all-cause mortality. Secondary endpoints included readmission for myocardial infarction (MI), stroke, repeat revascularization, and all-cause rehospitalization. Multivariable Cox regression was used to adjust for baseline characteristics.

Of 1774 screened patients, 632 met inclusion criteria (CABG: n = 97; PCI: n = 535). At 10 years, all-cause mortality was significantly lower in the CABG group (62.4 %) compared to PCI (71.8 %) (adjusted hazard ratio [aHR] 0.65, 95 % CI 0.47–0.92; p = 0.014). CABG was also associated with markedly lower rates of MI readmission (3.2 % vs. 23.7 %; aHR 0.11, 95 % CI 0.03–0.38; p < 0.001) and repeat revascularization (6.4 % vs. 21.6 %; aHR 0.22, 95 % CI 0.09–0.53; p = 0.001). Rates of stroke (p = 0.757) and all-cause rehospitalization (p = 0.157) were not significantly different.

In patients with 3VD and HF, CABG is associated with significantly improved long-term survival, reduced MI readmissions, and fewer repeat revascularizations compared to PCI. These findings reinforce the need for a multidisciplinary Heart Team review to ensure the optimal intervention strategy.

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•632 patients with three vessel coronary disease and heart failure underwent either CABG or PCI•10-year mortality was significantly lower in patients undergoing CABG compared to PCI (p = 0.015)•Readmission for myocardial infarction and repeat revascularization also favored CABG•Rehospitalization and stroke did not differ significantly between groups•CABG provides significant long term benefits over PCI for patients with multivessel disease and heart failure

632 patients with three vessel coronary disease and heart failure underwent either CABG or PCI

10-year mortality was significantly lower in patients undergoing CABG compared to PCI (p = 0.015)

Readmission for myocardial infarction and repeat revascularization also favored CABG

Rehospitalization and stroke did not differ significantly between groups

CABG provides significant long term benefits over PCI for patients with multivessel disease and heart failure