Ten-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with three-vessel disease and heart failure
Bibliographic record
Abstract
The optimal revascularization strategy for patients with three-vessel coronary artery disease (3VD) and heart failure (HF) remains uncertain due to the absence of randomized trials directly comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). With few observational studies providing long-term follow-up, clinical equipoise persists. We therefore evaluated 10-year outcomes between CABG and PCI in patients with HF and 3VD. This retrospective population-based cohort study included adults with 3VD and HF undergoing isolated CABG or PCI in Edmonton, Alberta, Canada (2009–2018). Patients with STEMI, prior CABG, or concomitant procedures were excluded. The primary endpoint was all-cause mortality. Secondary endpoints included readmission for myocardial infarction (MI), stroke, repeat revascularization, and all-cause rehospitalization. Multivariable Cox regression was used to adjust for baseline characteristics. Of 1774 screened patients, 632 met inclusion criteria (CABG: n = 97; PCI: n = 535). At 10 years, all-cause mortality was significantly lower in the CABG group (62.4 %) compared to PCI (71.8 %) (adjusted hazard ratio [aHR] 0.65, 95 % CI 0.47–0.92; p = 0.014). CABG was also associated with markedly lower rates of MI readmission (3.2 % vs. 23.7 %; aHR 0.11, 95 % CI 0.03–0.38; p < 0.001) and repeat revascularization (6.4 % vs. 21.6 %; aHR 0.22, 95 % CI 0.09–0.53; p = 0.001). Rates of stroke ( p = 0.757) and all-cause rehospitalization ( p = 0.157) were not significantly different. In patients with 3VD and HF, CABG is associated with significantly improved long-term survival, reduced MI readmissions, and fewer repeat revascularizations compared to PCI. These findings reinforce the need for a multidisciplinary Heart Team review to ensure the optimal intervention strategy. • 632 patients with three vessel coronary disease and heart failure underwent either CABG or PCI • 10-year mortality was significantly lower in patients undergoing CABG compared to PCI ( p = 0.015) • Readmission for myocardial infarction and repeat revascularization also favored CABG • Rehospitalization and stroke did not differ significantly between groups • CABG provides significant long term benefits over PCI for patients with multivessel disease and heart failure
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".