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).