PCI, CABG outcomes similar in multivessel coronary artery disease patients

In the treatment of patients with multivessel coronary artery disease, percutaneous coronary intervention (PCI) with everolimus-eluting stents appears to yield similar outcomes in terms of the incidence of major adverse cardiac events, the composite safety endpoint, and all-cause mortality, according to the results of the BEST trial.

BEST was designed to enrol 1,776 patients with angiographic multivessel coronary across 27 international heart centres. However, due to the slow enrolment, the study was terminated early and ended up with 880 patients, 438 of which were randomly assigned to the PCI group and 442 to the CABG group.

Over a median follow-up of 11.8 years, the frequency of the composite of death from any cause, myocardial infarction, or target vessel revascularization—the primary endpoint—did not significantly differ in the PCI and CABG groups (34.5 percent vs 30.3 percent; hazard ratio [HR], 1.18, 95 percent CI, 0.88–1.56; p=0.26).

Furthermore, there were no significant between-group differences noted in the occurrence of a safety composite of death, myocardial infarction, or stroke (28.8 percent vs 27.1 percent; HR, 1.07, 95 percent CI, 0.75–1.53; p=0.70), as well as the occurrence of death from any cause (20.5 percent vs 19.9 percent; HR, 1.04, 95 percent CI, 0.65–1.67; p=0.86).

However, compared with CABG, PCI was associated with a higher frequency of spontaneous myocardial infarction (7.1 percent vs 3.8 percent; HR, 1.86, 95 percent CI, 1.06–3.27; p=0.031) and any repeat revascularization (22.6 percent vs 12.7 percent; HR, 1.92, 95 percent CI, 1.58–2.32; p<0.001).