Coronary Artery Bypass Graft Versus Percutaneous Coronary Intervention: Meds Matter: Impact of Adherence to Medical Therapy on Comparative Outcomes
Authors' conclusion
Regardless of coronary revascularization strategy, medication adherence has a dramatic effect on long-term outcome. Among comparable patients who adhere to optimal medical therapy, outcomes of PCI and CABG may not differ; however, among nonadherent patients, CABG affords better major adverse cardiac event-free survival.
Study context
- Population
- NSTEMI patients undergoing coronary revascularization
- Participants
- 973 vs 2,255
- Exposure
- Coronary artery bypass graft (CABG) vs percutaneous coronary interventions (PCI), by adherence to optimal medical therapy
- CABGn = 973reference
- PCIn = 2,255
- Outcome
- MACE:
- All-cause mortality
- Nonfatal MI
- Reintervention
- Follow-up
- Up to 8 years
Methodological details8-hospital network, propensity score matching
- 8-hospital network
- Propensity score matching
Main finding
As reported in the abstract
MACE (all-cause mortality, nonfatal MI, reintervention), Cox regression
HR for MACE (95% CI)P value
Noncompliance with optimal medical therapy vs Compliance95% confidence limits
2.79(2.19–3.54)
P < 0.001- PCI vs CABG · 95% confidence limits; lower limit as printed
- HR for MACE 1.68 (95% CI 138–2.04); P < 0.001
- Propensity-matched, nonadherent to optimal medical therapy: CABG outcomes superior to PCI
- P = 0.001
- Propensity-matched, adherent to optimal medical therapy: CABG and PCI outcomes not different
- P = 0.574
Observational data: associations, not effects.
Further findings
MACE-free survival, propensity-matched, by adherence (subgroup)
- Nonadherent: CABG superior to PCI
- P = 0.001
- Adherent: CABG and PCI not different
- P = 0.574
- Propensity-matched
Original publication
Coronary Artery Bypass Graft Versus Percutaneous Coronary Intervention: Meds Matter: Impact of Adherence to Medical Therapy on Comparative Outcomes. Circulation. Published 25 October 2016. doi:10.
Summarised from the published abstract; every number is checked against it