Coronary Artery Bypass Grafting versus Stenting for Right Coronary Artery Territory

Abstract

95% CI: 0.748-1.471; 1. Background

The choice of treatment for right coronary artery (RCA) territory is a seriously controversial issue. The aim of this study was to compare clinical outcomes and long-term patency of RCA territory revascularization with off-pump coronary artery bypass graft (OPCAB) or percutaneous coronary intervention (PCI).

2. Materials and Methods

From January 2001 to December 2009, 1,672 patients underwent right-sided revascularization by OPCAB. From January 2003 to December 2011, 795 patients underwent right-sided revascularization by PCI with a drug-eluting stent (DES). Propensity score analysis was performed to control selection bias. Clinical outcomes such as all-cause and cardiac-related mortality and major adverse cardiac or cerebrovascular events (MACCE) were compared. Long term graft patency in patients treated with OPCAB was also determined. Clinical and angiographic data were analyzed.

3. Results

In propensity-matched patients, there were 5 (0.4%) early mortalities in the OPCAB group and 9 (1.3%) in the PCI group (p = 0.065). Overall survival at 5 years were not significantly different between the two groups (HR for the PCI group: 1.049; p = 0.781). Cardiac-related survival at 5 years was significantly higher in the OPCAB group than that in the PCI group (HR for the PCI group: 2.445; 95% CI: 1.296-4.611; p = 0.006). Freedom from stroke at 5 years did not differ significantly between the two groups (HR for the PCI group: 1.171; 95% CI: 0.633-2.168; p = 0.615). Freedom from myocardial infarction (MI) at 5 years was significantly higher in the OPCAB group than that in the PCI group (HR for the PCI group: 2.571; 95% CI: 1.241-5.328; p = 0.011). Freedom from target vessel revascularization (TVR) at 5 years was significantly higher in the OPCAB group than that in the PCI group (HR for the PCI group: 3.337; 95% CI: 2.010-5.540; p < 0.001). Freedom from MACCE at 5 years was significantly higher in the OPCAB group than that in the PCI group (HR for the PCI group: 2.291; 95% CI: 1.804-2.910; p < 0.001). The right internal thoracic artery (RITA) group showed the highest patency rate among groups, including the PCI group in the RCA territory.

4. Conclusion

OPCAB was superior to PCI with DES in patients with RCA disease with respect to cardiac-related mortality, MI, TVR and MACCE. The incidences of early mortality, overall mortality, and stroke was not significantly different between the OPCAB group and the PCI group. RITA had the highest long term patency among graft conduits. Therefore, a RITA graft should be considered as the first treatment choice for patients with RCA territory disease in OPCAB.