The effect of coronary revascularization treatment timing on cardiovascular outcomes in patients with ischemic heart disease

Background: There is little evidence on whether the timing of revascularization affects cardiovascular disease progression in patients with stable ischemic heart disease. We aimed to determine if disease progression differed between patients who underwent coronary artery bypass graft (CABG) surgery after the time recommended by physicians compared to timely percutaneous coronary intervention (PCI). Methods: We identified 25,469 British Columbia, Canada residents ages 60 years or older who underwent their first non-emergency revascularization for angiographically proven, stable left main or multi-vessel ischemic heart disease. We estimated the cumulative incidence of a composite cardiovascular outcome (CVO) and death as a competing risk for patients undergoing delayed CABG versus timely PCI. Results: After adjustment, patients who underwent delayed CABG had a statistically significantly lower cumulative CVO incidence at three years compared with those who received timely PCI (9.6% delayed CABG, 23.2% timely PCI; subdistribution hazard ratio for CVO at three years 0.50, 95% CI 0.26 - 0.99). Conclusion: Our results suggest that for patients who wish to wait for CABG, doing so may lead to slower disease progression compared with receiving PCI. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded by a Canadian Institutes of Health Research project grant (Funding Reference Number 353891). The funders had no role in the design of the review, the data collection, analysis, and interpretation of the data, or in writing the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The University of British Columbia's Clinical Research Ethics Board gave ethical approval of this research (Certificate Number H17-00505). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Access to data provided by the Data Stewards is subject to approval but can be requested for research projects through the Data Stewards or their designated service providers. All inferences, opinions, and conclusions drawn in this publication are those of the author(s), and do not reflect the opinions or policies of the Data Stewards.