Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Chronic total occlusion of Coronary Arteries

Abstract

Background: Chronic total occlusion (CTO) of the coronary arteries poses a major clinical challenge associated with adverse outcomes, such as myocardial infarction and increased mortality. The two primary revascularization strategies for managing CTOs are PCI and CABG. However, both these techniques get advanced over the years, and the best treatment approach remains debatable.

Objective: This study aimed to compare the efficacy, safety, and long-term outcomes of PCI and CABG in the treatment of CTOs, focusing on major adverse cardiac events (MACE) and hospitalization duration.

Methods: This cross-sectional survey was conducted at the Department of Cardiology, Services Hospital, Lahore from March 2022 to September 2022. The total study population included 56 patients diagnosed with CTO of coronary vessels, divided equally into two treatment strategies: PCI (n = 28) versus CABG (n = 28). Identification of patients was carried out using pertinent diagnostic and procedural codes obtained from electronic medical records. It was total data collection including demographics (age and sex), clinical characteristics, and angiographic findings (lesion site and the vessel involved). Procedural details and the approach followed to the PCI (whether antegrade or retrograde) were recorded. The follow-up assessments aimed to the incidence of MACE, such as myocardial infarction, stroke, cardiac death, while the secondary endpoints evaluated were procedural success rates, length of stay in the hospital, quality of life. The data was analyzed using SPSS version 25. The results are expressed on categorical variables in terms of frequencies and percentages and on continuous data as means ± standard deviation. The Mann-Whitney U test was made, while the Chi-square test was carried out to make statistical comparisons of continuous and categorical variables, respectively, applied at p < 0.05 to declare a significant difference.

Results: The incidence of myocardial infarction was 12.3% in the PCI group and 7.5% in the CABG group, with non-significant difference (p=1.0). Stroke rates were 6.2% for PCI and 3.8% for CABG, while cardiac death rates were 7.7% for PCI and 5% for CABG, both showing non-significant differences (p=1.0). Composite MACE occurred in 23.1% of PCI patients compared to 15% of CABG patients (p=0.727). Mean total hospitalization duration was significantly shorter for PCI patients (5.8 ± 1.2 days) than for CABG patients (8.5 ± 2.3 days) (p<0.001). ICU stay was also shorter for PCI patients (1.2 ± 0.4 days) compared to CABG patients (2.5 ± 0.7 days) (p<0.001).

Conclusion: This study found non-significant differences in major adverse cardiac events between PCI and CABG for the treatment of CTO of coronary arteries. However, significant differences in hospitalization duration and ICU stay were observed, with CABG patients requiring longer hospital stays. These findings highlight the need for individualized treatment plans considering patient-specific factors and procedural risks.