Abstract P221: Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Patients With Severe Left Ventricular Dysfunction: Superior Outcomes With Surgery
Bibliographic record
Abstract
Background: The efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD) has been well-defined by randomized controlled trials. However, patients with severe left ventricular dysfunction (ejection fraction <35%; EF) were under-represented in these trials. We sought to compare the outcomes of patients with multivessel CAD and EF<35% undergoing CABG vs. PCI. Methods: We used APPROACH, a clinical data collection initiative, capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, to identify 2477 patients with multivessel CAD and EF<35% undergoing CABG (n=1242) or PCI (n=1235) between 1995 and 2008. Results: Patients undergoing CABG were slightly older (65.8 vs. 65.3 years; p=0.269), more likely to have three vessel CAD (62% vs. 56%; p<0.001), male gender (85% vs. 77%; p<0.001), diabetes (39% vs. 27%; p<0.001), peripheral vascular disease (PVD; 14% vs. 8%, p<0.001), congestive heart failure (CHF; 46% vs. 41%, p=0.012), and COPD (21% vs. 16%, p=0.005). Unadjusted survival at 1, 5, and 12 years in the CABG vs. PCI groups was 90% vs. 86%, 75% vs 71%, and 47% vs. 48%, respectively (p=0.394). After controlling for differences in baseline risk factors, CABG was associated with improved long term outcomes. Multivariable logistic regression identified PCI was significantly associated with a higher risk of death compared to CABG (adjusted hazard ratio, 1.20; 95% CI, 1.03 to 1.40). Other significant predictors of poor long-term survival included COPD (adjusted hazard ratio, 1.19; 95% CI, 1.01 to 1.40), renal failure (adjusted hazard ratio, 2.33; 95% CI, 1.80 to 3.04), CHF (adjusted hazard ratio, 1.19; 95% CI, 1.04 to 1.37), diabetes (adjusted hazard ratio, 1.21; 95% CI, 1.06 to 1.40), PVD (adjusted hazard ratio, 1.31; 95% CI, 1.09 to 1.59), and prior CABG (adjusted hazard ratio, 1.30; 95% CI, 1.04 to 1.62). Conclusion: In patients with multivessel CAD and left ventricular dysfunction, CABG was associated with better survival than PCI after adjustment for baseline risk profile differences. Further research exploring the factors leading to use of a particular revascularization modality is required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".