The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease

Objectives In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed amongst patients who had coronary artery bypass graft (CABG) surgery after the time recommended by physicians compared to those who had timely percutaneous coronary intervention (PCI). Methods We identified 25,520 British Columbia residents 60 years or older who underwent first-time non-emergency revascularization for angiographically-proven, stable left main or multi-vessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged PCI for patients undergoing delayed CABG compared to timely PCI. Results After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed CABG had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely PCI (4.84% delayed CABG, 12.32% timely PCI; subdistribution hazard ratio 0.16, 95% CI 0.04 – 0.65). Conclusions Patients who undergo delayed CABG have a lower cumulative incidence of repeat revascularization than patients who undergo timely PCI. Patients who wish to wait to receive CABG will see the benefit of lower repeat revascularization over PCI unaffected by a delay in treatment.