Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: A report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators

Background studies of survival of patients with multivessel coronary artery disease (MVD) in the prestent era suggested that outcomes after coronary a rtery bypass surgery (CABG) are similar to those after percutaneous coronar y intervention (PCI) in subsets of coronary severity. The purpose of this s tudy of the Alberta Provincial Project for Outcome Assessment in Coronary H eart Disease (APPROACH) was to examine the association between treatment an d survival vp to 5 years in patients with MVD enrolled from 1995 through 19 98. Methods and Results Data on patient characteristics were obtained at the ti me of the initial coronary angiography. Survival was determined through dat a linkage to the provincial Bureau of Vital Statistics. Risk-adjusted hazar d ratios were calculated to compare different treatments. In the 11,661 pat ients with MVD, CABG was the initial therapy in 3782, PCI in 3540, and medi cal therapy in 4339. Cumulative 5-year survival was 91.4% with CABG, 91.9% with PCI, and 82.9% with medical therapy (P < .001). Hazard ratios were CAB G: medical 0.53 (95% confidence interval [CI] 0.46-0.71), PCI: medical 0.55 (95% CI 0.56-0.74), and CABG: PCI 0.81 (95% CI 0.68-0.96). Analysis across coronary severity groups revealed a benefit of CABG compared with PCI only in the group with severe left main CAD: 0.30 (95% CI 0.17-0.54). Conclusions In a multicenter clinical setting, MVD patients treated with re vascularization have significantly higher 5-year survival Fate than do thos e treated medically. Risk-adjusted comparison reveals PCI treatment to be a ssociated with long-term survival similar to treatment with CABG in all cor onary severity subgroups except the group with severe left main coronary ar tery disease. Patient selection Factors are likely to be contributing to th ese findings.