10-Year Data From BEST Trial Find No Significant Safety or MACE Differences Between PCI With EES Versus CABG

September 19, 2022—Ten-year outcomes from the BEST trial found that there was no significant difference in safety and major adverse cardiac event outcomes at 10 years between percutaneous coronary intervention (PCI) with an everolimus-eluting stent (EES) versus coronary artery bypass grafting (CABG). However, spontaneous myocardial infarction and repeat revascularizations occurred more frequently with PCI compared to CABG.

The BEST trial’s long-term findings were reported at TCT 2022, the 34th annual Transcatheter Cardiovascular Therapeutics scientific symposium of the Cardiovascular Research Foundation held September 16-19 in Boston, Massachusetts. The findings were published online by Jung-Min Ahn, MD, et al in Circulation.

Dr. Ahn, who is with Asan Medical Center in Seoul, South Korea, commented in the TCT press release, “Over an extended follow-up of up to 14 years, there were no significant differences in the rates of major adverse cardiac events, serious composite outcomes, and mortality for PCI compared to CABG. Having this specific type of very long-term data could aid in making treatment decisions for patients with multivessel coronary artery disease.”

According to TCT, the prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers. Between July 2008 and September 2013, a total of 880 patients with angiographic multivessel CAD amenable to either PCI or CABG were randomly assigned to PCI with an EES (n = 438) or CABG (n = 442).

As noted in the TCT press release, follow-up was originally scheduled at 30 days and 6, 9, and 12 months, then annually for up to 5 years. The study was terminated early because of slow enrollment in October 2013 and reported findings with a median clinical follow-up of 4.6 years.

In February 2022, the principal investigator invited participation from all 27 heart centers for an extended follow-up study with a minimum and maximum follow-up of 8 and 14 years, respectively.

The primary endpoint was the composite of death from any cause, myocardial infarction, or target vessel revascularization.

As summarized in the TCT press release, during a median follow-up of 11.8 years (IQR, 10.6 to 12.5 years), the primary endpoint occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18; 95% CI, 0.88-1.56; P = .26).

There were no significant differences in the occurrence of a safety composite of death, myocardial infarction, or stroke between the PCI and CABG groups (28.8% vs 27.1%; HR, 1.07; 95% CI, 0.75-1.53; P = .7), as well as death from any cause (20.5% vs 19.9%; HR, 1.04; 95% CI, 0.65-1.67; P = .86).

Spontaneous myocardial infarction (7.1% vs 3.8%; HR, 1.86; 95% CI, 1.06-3.27; P = .031) and repeat revascularization (22.6% vs 12.7%; HR, 1.92; 95% CI, 1.58-2.32; P < .001) occurred more frequently after PCI than after CABG, noted the TCT press release.