Off-Pump Coronary Artery Bypass Graft Versus Drug-Eluting Stent Implantation in Patients with Multivessel Disease Involving the Right Coronary Artery.

BACKGROUND:  Whether percutaneous coronary intervention (PCI) is superior to coronary artery bypass grafting (CABG) for the right coronary territory is unknown. The aim of this study was to compare the outcomes and patency in the right coronary territory after CABG or PCI.

METHODS:  We studied 2,467 multivessel coronary artery disease patients from January 2001 to December 2011; 1,672 were off-pump CABG patients and 795 were PCI. The graft patency and the presence of major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, target vessel revascularization, and stroke were analyzed.

RESULTS:  After propensity score matching, cardiac-related survival was found to be significantly higher in the CABG group than in the PCI group (hazard ratio (HR) for the PCI group: 2.445, p  = 0.006). The PCI group showed higher rates of myocardial infarction (HR: 2.571, p  = 0.011) and target vessel revascularization (HR: 3.337, p  < 0.001). In the right coronary territory, the right internal thoracic artery patency was not different in the PCI group compared with the CABG group ( p  = 0.248). In CABG group, low right coronary artery graft patency was associated with cardiac-related death (HR: 0.17, p  = 0.003) and the occurrence of MACCEs (HR: 0.22, p  < 0.001).

CONCLUSION:  CABG was superior to PCI in patients with multivessel disease. Low graft patency in the right coronary territory was associated with cardiac-related death and the occurrence of MACCEs.