Vergelijking tussen PCI en CABG bij ernstig coronairlijden*

Objective

To determine in a randomized trial whether percutaneous coronary intervention (PCI) involving drug-eluting stents produces comparable results to coronary-artery bypass grafting (CABG) for the treatment of patients with three-vessel or left main coronary artery disease.

Design

Randomized clinical trial (http://clinicaltrials.gov/ct2/show/NCT00114972).

Method

1800 patients with three-vessel or left-main coronary artery disease were randomized to treatment with CABG or PCI, in a 1:1 ratio. A non-inferiority comparison between the two groups was performed for the primary endpoint ‘major adverse cerebrovascular or cardiac events’ during the 12-month period following randomization. Patients with an absolute indication for one of the two treatments were included in a parallel preference registry.

Results

After 12 months, rates of major adverse cerebrovascular or cardiac events were higher in the PCI group than in the CABG group, by 17.8 and 12.4% respectively (p = 0.002). Complications were comparable in the subgroup with an angiographic score (SYNTAX score) < 22, indicating that PCI could be a good alternative for this subgroup.

Conclusion

This study shows that CABG is associated with fewer major cardiac and cerebrovascular events in patients with three-vessel or left main coronary artery disease when compared with PCI.