Comparative Effectiveness of CABG and PCI ORIGINAL RESEARCH Table Baseline Clinical Characteristics All Patients, Propensity Score-Matched Patients, cABG(n=194223) Pc|n=57330) cABG(n=5257Pa(m=52578) 6670y 31.3 29.0 270 7344 23.1 23.3 6.8 433 9 925 33.4 Chronic kidney disease Peripheral arterial disease 21.6 Cerebrovascular disease Prior MI 13.4 11.4 Heart failure 13.9 13.2 Atrial fibrillation Primary diagnosis of MI 4.4 Middle Atlantic South atlanti East South Central West South Central 11.8 11.8 11.8 East North Central 19.9 20.1 West North Central Pacific 8.6 Year of procedure 2.6 1995-2003 479 33.6 CABG coronary artery bypass graft; MI myocardial infarction: PCI percutancous coronary intervention Role of the Funding Source whom had multivessel CABG and 57 330 of whom had The National Heart, Lung, and Blood Institute spon- multivessel PCI ored the study but had no role in its design or conduct; In the propensity score analysis, the strongest predi the collection, management, analysis, or interpretation of tors of receiving CABG rather than PCI were calendar the data; or the preparation, review, or apl year,age, sex, diabetes, cerebrovascular disease, peripheral manuscript arterial disease, atrial fibrillation, and region. The propen- sity score model had an overall c-statistic of 0.673. We matched 92% of the patients who had multivessel PCI RESULTS with patients who had multivessel CABG; 10 080 patient e identified 611 729 initial CABG and PCI proce pairs were matched on 5 to 7 digits of propensity score, dures between 1992 and 2008 in the 20% sample of Medi- 16 677 on 4 digits, 20 767 on 3 digits, and 5054 on 2 care beneficiaries aged 66 years or older with available Part digits B data. We excluded 48 707 patients because of concomi- cant cardiac procedures performed at the time of CABG or population were similar between patients who received PCI, 300 378 who had single-vessel revascularization, CABG and those who received PCI Table). The typical 2982 because the number of treated vessels could not be patient was a 75-year-old white man with hypertension measured,and 8109 with end-stage renal disease. The eli- and the median follow-up was 4.3 years. Overall, survival ble population comprised 251 553 patients; 194 223 of at 5 years was 74. 1% after CABG and 71.9%after PCIRole of the Funding Source The National Heart, Lung, and Blood Institute spon￾sored the study but had no role in its design or conduct; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. RESULTS We identified 611 729 initial CABG and PCI proce￾dures between 1992 and 2008 in the 20% sample of Medi￾care beneficiaries aged 66 years or older with available Part B data. We excluded 48 707 patients because of concomi￾tant cardiac procedures performed at the time of CABG or PCI, 300 378 who had single-vessel revascularization, 2982 because the number of treated vessels could not be measured, and 8109 with end-stage renal disease. The eli￾gible population comprised 251 553 patients; 194 223 of whom had multivessel CABG and 57 330 of whom had multivessel PCI. In the propensity score analysis, the strongest predic￾tors of receiving CABG rather than PCI were calendar year, age, sex, diabetes, cerebrovascular disease, peripheral arterial disease, atrial fibrillation, and region. The propen￾sity score model had an overall c-statistic of 0.673. We matched 92% of the patients who had multivessel PCI with patients who had multivessel CABG; 10 080 patient pairs were matched on 5 to 7 digits of propensity score, 16 677 on 4 digits, 20 767 on 3 digits, and 5054 on 2 digits. The baseline clinical characteristics of the matched population were similar between patients who received CABG and those who received PCI (Table). The typical patient was a 75-year-old white man with hypertension, and the median follow-up was 4.3 years. Overall, survival at 5 years was 74.1% after CABG and 71.9% after PCI Table. Baseline Clinical Characteristics Characteristic All Patients, % Propensity Score–Matched Patients, % CABG (n
194 223) PCI (n
57 330) CABG (n
52 578) PCI (n
52 578) Age 66–70 y 31.3 29.0 30.0 29.8 71–75 y 31.8 27.0 27.6 27.9 76–80 y 24.1 22.7 23.1 23.3 81–85 y 10.7 14.6 14.7 14.6 86 y 2.1 6.8 4.6 4.4 Female 33.8 43.3 41.2 42.0 Race White 92.4 91.9 92.5 92.1 Black 4.3 4.6 4.4 4.6 Other 3.3 3.5 3.2 3.3 Diabetes 36.0 33.4 33.3 33.3 Hypertension 77.6 78.7 78.5 78.6 Hyperlipidemia 29.1 28.0 28.0 28.5 Tobacco use 18.1 18.6 18.1 19.0 Chronic kidney disease 5.1 5.7 5.4 5.5 Peripheral arterial disease 21.6 18.2 17.4 18.3 Cerebrovascular disease 22.0 16.9 16.6 16.9 Prior MI 13.4 11.6 10.9 11.4 Heart failure 13.1 13.9 12.5 13.2 Unstable angina 38.4 29.5 30.4 29.9 Atrial fibrillation 9.5 12.2 11.2 11.6 Primary diagnosis of MI 21.4 29.6 28.2 28.4 Metropolitan area 72.4 73.0 73.0 73.0 U.S. Census region New England 4.4 4.3 4.2 4.4 Middle Atlantic 13.5 11.9 12.0 12.3 South Atlantic 21.7 21.6 21.5 21.4 East South Central 8.9 7.1 7.1 7.3 West South Central 12.1 11.8 11.8 11.8 East North Central 19.9 19.6 20.2 20.1 West North Central 8.4 10.1 10.3 9.9 Mountain 3.7 4.9 4.6 4.6 Pacific 7.3 8.6 8.4 8.3 Year of procedure 1992–1994 7.6 3.2 2.6 2.6 1995–2003 58.9 46.8 47.9 47.9 2004–2008 33.6 50.0 49.5 49.5 CABG coronary artery bypass graft; MI myocardial infarction; PCI percutaneous coronary intervention. Comparative Effectiveness of CABG and PCI Original Research www.annals.org 21 May 2013 Annals of Internal Medicine Volume 158 • Number 10 729