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Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England.
Circulation. 2005 Aug 30; 112(9 Suppl):I371-6.Circ

Abstract

BACKGROUND

Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice.

METHODS AND RESULTS

From our northern New England registries of consecutive coronary revascularizations, we identified 10,198 CABG and 4,295 PCI patients with MVD who may have been eligible for either procedure between 1994 and 2001. Vital status was obtained by linkage to the National Death Index. Proportional-hazards regression was used to calculate hazard ratios (HRs) for survival in CABG vs PCI patients after adjustment for comorbidities and disease characteristics. CABG patients were older; had more comorbidities, more 3-vessel disease, and lower ejection fractions; and were more completely revascularized. Adjusted long-term survival for patients with 3-vessel disease was better after CABG than PCI (HR, 0.60; P<0.01) but not for patients with 2-vessel disease (HR, 0.98; P=0.77). The survival advantage of CABG for 3-vessel disease patients was present in all patient populations, including women, diabetics, and the elderly and in the era of high stent utilization.

CONCLUSIONS

In contemporary practice, survival for patients with 3-vessel coronary disease is better after CABG than PCI, an observation that patients and physicians should carefully consider when deciding on a revascularization strategy.

Authors+Show Affiliations

Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. David.Malenka@Hitchcock.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16159849

Citation

Malenka, David J., et al. "Comparing Long-term Survival of Patients With Multivessel Coronary Disease After CABG or PCI: Analysis of BARI-like Patients in Northern New England." Circulation, vol. 112, no. 9 Suppl, 2005, pp. I371-6.
Malenka DJ, Leavitt BJ, Hearne MJ, et al. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation. 2005;112(9 Suppl):I371-6.
Malenka, D. J., Leavitt, B. J., Hearne, M. J., Robb, J. F., Baribeau, Y. R., Ryan, T. J., Helm, R. E., Kellett, M. A., Dauerman, H. L., Dacey, L. J., Silver, M. T., VerLee, P. N., Weldner, P. W., Hettleman, B. D., Olmstead, E. M., Piper, W. D., & O'Connor, G. T. (2005). Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation, 112(9 Suppl), I371-6.
Malenka DJ, et al. Comparing Long-term Survival of Patients With Multivessel Coronary Disease After CABG or PCI: Analysis of BARI-like Patients in Northern New England. Circulation. 2005 Aug 30;112(9 Suppl):I371-6. PubMed PMID: 16159849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. AU - Malenka,David J, AU - Leavitt,Bruce J, AU - Hearne,Michael J, AU - Robb,John F, AU - Baribeau,Yvon R, AU - Ryan,Thomas J, AU - Helm,Robert E, AU - Kellett,Mirle A, AU - Dauerman,Harold L, AU - Dacey,Lawrence J, AU - Silver,M Theodore, AU - VerLee,Peter N, AU - Weldner,Paul W, AU - Hettleman,Bruce D, AU - Olmstead,Elaine M, AU - Piper,Winthrop D, AU - O'Connor,Gerald T, AU - ,, PY - 2005/9/15/pubmed PY - 2006/2/24/medline PY - 2005/9/15/entrez SP - I371 EP - 6 JF - Circulation JO - Circulation VL - 112 IS - 9 Suppl N2 - BACKGROUND: Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice. METHODS AND RESULTS: From our northern New England registries of consecutive coronary revascularizations, we identified 10,198 CABG and 4,295 PCI patients with MVD who may have been eligible for either procedure between 1994 and 2001. Vital status was obtained by linkage to the National Death Index. Proportional-hazards regression was used to calculate hazard ratios (HRs) for survival in CABG vs PCI patients after adjustment for comorbidities and disease characteristics. CABG patients were older; had more comorbidities, more 3-vessel disease, and lower ejection fractions; and were more completely revascularized. Adjusted long-term survival for patients with 3-vessel disease was better after CABG than PCI (HR, 0.60; P<0.01) but not for patients with 2-vessel disease (HR, 0.98; P=0.77). The survival advantage of CABG for 3-vessel disease patients was present in all patient populations, including women, diabetics, and the elderly and in the era of high stent utilization. CONCLUSIONS: In contemporary practice, survival for patients with 3-vessel coronary disease is better after CABG than PCI, an observation that patients and physicians should carefully consider when deciding on a revascularization strategy. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/16159849/Comparing_long_term_survival_of_patients_with_multivessel_coronary_disease_after_CABG_or_PCI:_analysis_of_BARI_like_patients_in_northern_New_England_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.526392?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -