Evidence-Based Optimal Myocardial Revascularization:Perspective from the CREDO-Kyoto Registry

(Department of Cardiovascular Surgery1, and Department of Cardiovascular Medicine2, Kyoto University Graduate School of Medicine, Kyoto, Japan, Department of Cardiovascular Surgery, Iwate Medical University School of Medicine3, Morioka, Japan, and Department of Cardiovascular Surgery, Kurashiki Central Hospital4, Kurashiki, Japan)

Akira Marui1,2 Hitoshi Okabayashi3 Tatsuhiko Komiya4
Ryuzo Sakata1 The CREDO-Kyoto Investigators
Although there have been several studies that compared the efficacy of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG), the impact of off-pump CABG(OPCAB)has not been well elucidated. Among the 9,877 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto Registry(a registry of first-time PCI using bare-metal stents and CABG patients in Japan), 6,327 patients with multivessel and/or left main disease were enrolled in the present study(PCI 3,877/CABG 2,450). Median follow-up was 3.5 years. Propensity-score-adjusted all-cause mortality after PCI was higher than that of CABG(hazard ratio[95% confidence interval]:1.37[1.15-1.63], p<0.01). The incidence of stroke was lower after PCI than that after CABG(0.75[0.59-0.96], p=0.02). The predicted risk of operative mortality(PROM)of each patient of on-pump/off-pump CABG was calculated by the logistic EuroSCORE. Patients were divided into tertiles based on their PROM. The hazard ratio of the incidence of stroke in on-pump CABG compared with off-pump CABG in the high-risk tertile was 1.80([1.07-3.02], p=0.03). The adjusted overall mortality was not significantly different between the two procedures even in the high-risk tertile(1.44[0.98-2.11], p=0.06). In patients with multivessel and/or left main disease, CABG was associated with better survival outcomes than PCI using bare-metal stents. Off-pump CABG as opposed to on-pump CABG is associated with short-and long-term benefits in stroke prevention in patients with higher risk as evaluated by the EuroSCORE. No survival benefit of OPCAB was shown, regardless of preoperative risk level.
  Jpn. J. Cardiovasc. Surg. 42:16-22(2013)

Keywords:PCI, CABG, off-pump