Cardiovascular risks high after PCI, CABG but decrease in time

10 Feb 2024
Cardiovascular risks high after PCI, CABG but decrease in time

Early revascularization by percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), compared with a conservative (CON) strategy, may result in higher early risks but lower long-term risks of cardiovascular events in patients with stable coronary artery disease treated with an invasive (INV) strategy, a study has found.

Notably, the early risk was highest following CABG due to protocol-defined procedural myocardial infarctions (MIs).

In this study, the authors categorized patients without preceding primary outcome events as INV-PCI or INV-CABG from the time of revascularization. The primary outcome was defined as the composite of cardiovascular death, protocol-defined MI or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.

Primary outcome events occurred in 84 of 512 (16.4 percent) INV-CABG patients during a median follow-up of 2.85 years. Of these events, 48 (57.2 percent) occurred within 30 days following CABG, including 40 procedural MIs. Among 1,500 INV-PCI patients, 147 (9.8 percent) experienced primary outcome events at a median follow-up of 2.94 years. Of these, 31 (21.1 percent) occurred within 30 days after PCI, including 24 procedural MIs.

On the other hand, primary outcome events occurred in 352 of 2,591 CON patients over a median follow-up of 3.2 years. Of these, 22 (6.3 percent) occurred within 30 days of randomization.

The adjusted risks for experiencing primary outcome events were higher within 30 days after both CABG and PCI (CABG: hazard ratio [HR], 16.25, 95 percent confidence interval [CI], 11.44‒23.07; PCI: HR, 2.99, 95 percent CI, 1.97‒4.53) and lower afterwards (CABG: HR, 0.63, 95 percent CI, 0.44‒0.89; PCI: HR, 0.66, 95 percent CI, 0.53‒0.82).

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