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Coronary Artery Bypass Grafts Cause Fewer Myocardial Infarctions than Stents: Presented at STS

By Mike Fillon

CHICAGO, IL -- February 1, 2006 -- Coronary artery bypass graft (CABG) surgery appears to result in fewer perioperative myocardial infarctions (MIs) compared with percutaneous coronary intervention (PCI) among patients scheduled for elective vascular surgery.

Results of the study, which involved a new subset of subjects from the phase 3 Coronary Artery Revascularization Prophylaxis (CARP) Trial, were presented here January 30^th at the Society of Thoracic Surgeons (STS) 42^nd Annual Meeting.

The study's lead researcher was Herbert B. Ward, MD, PhD, Chief, Cardiothoracic Surgery, Minneapolis Veterans Affairs Medical Center, Associate Chief, Division of Cardiovascular & Thoracic Surgery, University of Minnesota, Professor, Department of Surgery, University of Minnesota.

According to Dr. Ward, this is the first study to uncover the differences between CABG and PCI in preventing perioperative MI in subsequent vascular surgery. "We hypothesized that a more complete coronary revascularization procedure would improve outcomes following subsequent vascular surgery," he said.

The phase 3 CARP Trial, conducted between August 1997 and February 2004, was designed to compare myocardial revascularization with no revascularization prior to elective vascular surgery. The researchers found no difference in rates of death or MI between treatment groups.

In this substudy of CARP, the researchers investigated and compared the incidence of perioperative MIs and the extent of revascularization after CABG vs. PCI.

In their study, Dr. Ward and colleagues evaluated 222 patients undergoing prophylactic coronary artery revascularization at 18 Veterans Affairs Medical Centers. Local investigators at each treatment site selected the mode of revascularization, with a total of 91 patients receiving CABG and 131 receiving PCI.

CABG resulted in a significantly reduced incidence of perioperative MI despite more diseased vessels in the CABG group, with 6.6% of CABG patients experiencing an MI within 30 days, compared with 16.8% of patients receiving PCI.

The investigators noticed a trend towards shorter hospital stays among CABG patients, who spent an average of 6 days in the hospital after the elective vascular operation, compared with 7 days among the PCI patients.

Study results also show the likelihood of developing a perioperative MI was inversely correlated with the completeness of revascularization, defined as the number of vessels revascularized, compared with the number of major vessels exhibiting more than 70% stenosis. CABG was associated with 98.0% completeness of revascularization, compared with 61.9% with PCI (P = .001).

Mortality rates starting from the revascularization procedure and ending 3 months after the elective vascular surgery were not statistically different between the two techniques, Dr. Ward said. Eight patients in the CABG group died compared with nine in the PCI group.

The reason for the higher rate of MI in the PCI versus the CABG group is unknown, Dr. Ward said, but is most likely due to the complete revascularization in the CABG group. Other factors that might have contributed to the difference are the timing of the elective vascular operation or the fact that antiplatelet drugs were stopped for several days prior to the elective operation.


[Presentation title: Coronary Artery Bypass is Superior to Percutenous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery: The Coronary Artery Revascularization Prophylaxis (CARP) Trial. Abstract 9]

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