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Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease : the SWEDEHEART registry

Omerovic, Elmir ; Råmunddal, Truls ; Petursson, Petur ; Angerås, Oskar ; Rawshani, Araz ; Jha, Sandeep ; Skoglund, Kristofer ; Mohammad, Moman A. LU orcid ; Persson, Jonas and Alfredsson, Joakim , et al. (2025) In European Heart Journal 46(6). p.518-531
Abstract

Background and Aims The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated. Methods The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure.... (More)

Background and Aims The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated. Methods The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure. Multilevel logistic regression with follow-up time as a log-transformed offset variable and double-robust adjustment with the instrumental variable method were applied to control for known and unknown confounders. Results Percutaneous coronary intervention was the primary therapy in 42 190 (73.9%) patients, while 14 907 (26.1%) received CABG. Percutaneous coronary intervention patients were generally older with more prior cardiovascular events, whereas CABG patients had higher incidences of diabetes, hypertension, left main and three-vessel disease, and reduced ejection fraction. Over a median follow-up of 7.1 years, PCI was associated with higher risks of death [adjusted odds ratio (aOR) 1.67; 95% confidence interval (CI) 1.54–1.81] and MI (aOR 1.51; 95% CI 1.41–1.62) but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95% CI 2.57–3.51), while heart failure risk was 15% higher (aOR 1.15; 95% CI 1.07–1.25). Coronary artery bypass grafting provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though this benefit diminished over shorter time horizons. Conclusions Coronary artery bypass grafting is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.

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type
Contribution to journal
publication status
published
subject
keywords
Coronary artery bypass grafting, Multivessel disease, Non-ST-segment elevation myocardial infarction, Percutaneous coronary intervention, Revascularization
in
European Heart Journal
volume
46
issue
6
pages
14 pages
publisher
Oxford University Press
external identifiers
  • pmid:39601339
  • scopus:85217512033
ISSN
0195-668X
DOI
10.1093/eurheartj/ehae700
language
English
LU publication?
yes
id
7bd3f30c-cdf3-4455-8f14-0036fdc95534
date added to LUP
2025-03-24 15:14:05
date last changed
2025-08-26 01:22:43
@article{7bd3f30c-cdf3-4455-8f14-0036fdc95534,
  abstract     = {{<p>Background and Aims The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated. Methods The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure. Multilevel logistic regression with follow-up time as a log-transformed offset variable and double-robust adjustment with the instrumental variable method were applied to control for known and unknown confounders. Results Percutaneous coronary intervention was the primary therapy in 42 190 (73.9%) patients, while 14 907 (26.1%) received CABG. Percutaneous coronary intervention patients were generally older with more prior cardiovascular events, whereas CABG patients had higher incidences of diabetes, hypertension, left main and three-vessel disease, and reduced ejection fraction. Over a median follow-up of 7.1 years, PCI was associated with higher risks of death [adjusted odds ratio (aOR) 1.67; 95% confidence interval (CI) 1.54–1.81] and MI (aOR 1.51; 95% CI 1.41–1.62) but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95% CI 2.57–3.51), while heart failure risk was 15% higher (aOR 1.15; 95% CI 1.07–1.25). Coronary artery bypass grafting provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though this benefit diminished over shorter time horizons. Conclusions Coronary artery bypass grafting is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.</p>}},
  author       = {{Omerovic, Elmir and Råmunddal, Truls and Petursson, Petur and Angerås, Oskar and Rawshani, Araz and Jha, Sandeep and Skoglund, Kristofer and Mohammad, Moman A. and Persson, Jonas and Alfredsson, Joakim and Hofmann, Robin and Jernberg, Tomas and Fröbert, Ole and Jeppsson, Anders and Hansson, Emma C. and Dellgren, Göran and Erlinge, David and Redfors, Björn}},
  issn         = {{0195-668X}},
  keywords     = {{Coronary artery bypass grafting; Multivessel disease; Non-ST-segment elevation myocardial infarction; Percutaneous coronary intervention; Revascularization}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{518--531}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease : the SWEDEHEART registry}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehae700}},
  doi          = {{10.1093/eurheartj/ehae700}},
  volume       = {{46}},
  year         = {{2025}},
}