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.com
Volume 9
Journal of Clinical & Experimental Cardiology
ISSN: 2155-9880
October 22-24, 2018 | Rome, Italy
27
th
European Cardiology Conference
Euro Cardiology 2018
October 22-24, 2018
Comparison of the outcomes of CABG vs PCI procedures in patients with poor left ventricular
function (ejection fraction <30%): A propensity-matched analysis
Shaneel Shah
Bristol Heart Institute, UK
Background:
Existing evidence comparing the outcomes of coronary artery bypass graft surgery (CABG) vs. percutaneous
coronary intervention (PCI) in patients with poor left ventricular function (LVF) is sparse and flawed. This is largely due to
patients with poor LVF being underrepresented in major research trials and the out-dated nature of some studies which do not
consider drug-eluting stent (DES) PCI.
Methodology:
Following strict inclusion criteria 717 patients who underwent revascularisation by CABG or PCI between 2002
and 2015 were enrolled. 100% of the patients had poor LVF (defined by ejection fraction <30%). By employing a propensity
score analysis, 186 suitable matches (93 CABG, 93 PCI) were identified. Several outcomes were evaluated, in the matched
population, using data extracted from national registry databases.
Results:
CABG patients required a longer length of hospital stay post-revascularisation compared to PCI, 8.91±1.38
and 4.96±1.38 days respectively (p<0.0001). Cox-regression proportional-hazards analysis found that PCI had a higher
adjusted 5-year mortality rate (HR 1.752, 95% CI 0.998-3.078, p=0.05). This trend was consistent amongst urgent cases of
revascularization, patients with 3 or more vessels with coronary artery disease, and cases where complete revascularization
was achieved. Sub-analysis found the cumulative 5-year survival distribution for PCI with DES to be significantly higher than
PCI without DES, but still lower than CABG (log-rank p=0.037; CABG 67.6±5.3%, PCI with DES 54.6±3.3%. PCI without
DES 46.2±4.7%).
Conclusions:
Despite a longer length of hospital stay, CABG patients experience a greater post-procedural survival benefit
compared to PCI patients. We have demonstrated this at 30 days, 90 days, 1 year, 3 years and 5 years following revascularisation.
At present, CABG remains a superior revascularization modality to PCI in patients with poor LVF.
Biography
Shaneel Shah is nearing completion of his undergraduate medical degree at the University of Bristol. During his short time in the medical profession he has
demonstrated his passion for cardiothoracic surgery on multiple occasions - most notably seen in his current position as president of the University of Bristol
Cardiothoracic Surgery Society. He has confidently and successfully presented at national conferences and looks forward to a career in cardiothoracic surgery.
Shaneel Shah, J Clin Exp Cardiolog 2018, Volume 9
DOI: 10.4172/2155-9880-C10-116