Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery Disease
- 22 April 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 117 (16), 2079-2086
- https://doi.org/10.1161/circulationaha.107.750109
Abstract
Background— Although previous studies have compared the treatment effects of percutaneous coronary intervention and coronary artery bypass grafting (CABG), the long-term outcomes beyond 1 year among patients with multivessel coronary artery disease who underwent percutaneous coronary intervention with drug-eluting stents (DES) or CABG have not been evaluated. Methods and Results— Between January 2003 and December 2005, 3042 patients with multivessel disease underwent coronary implantation of DES (n=1547) or CABG (n=1495). The primary end point was all-cause mortality. In a crude analysis, the rate of long-term mortality was significantly higher in patients who underwent CABG than in those who underwent DES implantation (3-year unadjusted mortality rate, 7.0% for CABG versus 4.4% for percutaneous coronary intervention; P =0.01). However, after adjustment for baseline differences, the overall risks of death were similar among all patients (hazard ratio, 0.85; 95% confidence interval [CI], 0.56 to 1.30; P =0.45), diabetic patients (hazard ratio, 1.76; 95% CI, 0.82 to 3.78; P =0.15), and patients with compromised ventricular function (hazard ratio, 1.39; 95% CI, 0.41 to 4.65; P =0.60). In the anatomic subgroups, mortality benefit with DES implantation was noted in patients with 2-vessel disease with involvement of the nonproximal left anterior descending artery (hazard ratio, 0.23; 95% CI, 0.01 to 0.78; P =0.016). The rate of revascularization was significantly higher in the DES than in the CABG group (hazard ratio, 2.81; 95% CI, 2.11 to 3.75; P Conclusions— For the treatment of multivessel coronary artery disease, percutaneous coronary intervention with DES implantation showed equivalent long-term mortality as CABG.Keywords
This publication has 36 references indexed in Scilit:
- Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery DiseaseCirculation, 2007
- Diabetic Endovascular Disease: Role of Coronary Artery RevascularizationThe American Journal of Cardiology, 2007
- Frequency of and Risk Factors for Stent Thrombosis After Drug-Eluting Stent Implantation During Long-Term Follow-UpThe American Journal of Cardiology, 2006
- The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: Design, rationale, and run-in phaseAmerican Heart Journal, 2006
- The Coronary ArteryRevascularisation in Diabetes (CARDia) trial: Background, aims, and designAmerican Heart Journal, 2005
- Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary ArteryNew England Journal of Medicine, 2003
- Diabetes and Vascular DiseaseCirculation, 2003
- Burgeoning Dilemmas in the Management of Diabetes and Cardiovascular DiseaseCirculation, 2003
- Comparison of Coronary-Artery Bypass Surgery and Stenting for the Treatment of Multivessel DiseaseNew England Journal of Medicine, 2001
- Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic statusJournal of the American College of Cardiology, 2000