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Coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stent implantation in patients with multivessel coronary disease.
J Interv Cardiol. 2007 Feb; 20(1):10-6.JI

Abstract

BACKGROUND

Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world.

METHODS

From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up.

RESULTS

Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 +/- 1.1 vs 3.3 +/- 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25+/-8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI.

CONCLUSION

PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis.

Authors+Show Affiliations

Department of Cardiology, RuiJin Hospital Affiliated to JiaoTong University, Shanghai, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17300391

Citation

Yang, Zhen Kun, et al. "Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention With Drug-eluting Stent Implantation in Patients With Multivessel Coronary Disease." Journal of Interventional Cardiology, vol. 20, no. 1, 2007, pp. 10-6.
Yang ZK, Shen WF, Zhang RY, et al. Coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stent implantation in patients with multivessel coronary disease. J Interv Cardiol. 2007;20(1):10-6.
Yang, Z. K., Shen, W. F., Zhang, R. Y., Kong, Y., Zhang, J. S., Hu, J., Zhang, Q., & Ding, F. H. (2007). Coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stent implantation in patients with multivessel coronary disease. Journal of Interventional Cardiology, 20(1), 10-6.
Yang ZK, et al. Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention With Drug-eluting Stent Implantation in Patients With Multivessel Coronary Disease. J Interv Cardiol. 2007;20(1):10-6. PubMed PMID: 17300391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stent implantation in patients with multivessel coronary disease. AU - Yang,Zhen Kun, AU - Shen,Wei Feng, AU - Zhang,Rui Yan, AU - Kong,Ye, AU - Zhang,Jian Sheng, AU - Hu,Jian, AU - Zhang,Qi, AU - Ding,Feng Hua, PY - 2007/2/16/pubmed PY - 2007/3/23/medline PY - 2007/2/16/entrez SP - 10 EP - 6 JF - Journal of interventional cardiology JO - J Interv Cardiol VL - 20 IS - 1 N2 - BACKGROUND: Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. METHODS: From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up. RESULTS: Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 +/- 1.1 vs 3.3 +/- 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25+/-8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI. CONCLUSION: PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis. SN - 0896-4327 UR - https://www.unboundmedicine.com/medline/citation/17300391/Coronary_artery_bypass_surgery_versus_percutaneous_coronary_intervention_with_drug_eluting_stent_implantation_in_patients_with_multivessel_coronary_disease_ L2 - https://doi.org/10.1111/j.1540-8183.2007.00222.x DB - PRIME DP - Unbound Medicine ER -