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Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.
Circulation 2007; 116(11 Suppl):I200-6Circ

Abstract

BACKGROUND

Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease.

METHODS AND RESULTS

A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19).

CONCLUSIONS

Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes. Coronary artery bypass surgery may be the preferred revascularization strategy in diabetic patients with multivessel coronary artery disease.

Authors+Show Affiliations

Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.No 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

Language

eng

PubMed ID

17846304

Citation

Javaid, Aamir, et al. "Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-eluting Stents for Patients With Multivessel Coronary Artery Disease." Circulation, vol. 116, no. 11 Suppl, 2007, pp. I200-6.
Javaid A, Steinberg DH, Buch AN, et al. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease. Circulation. 2007;116(11 Suppl):I200-6.
Javaid, A., Steinberg, D. H., Buch, A. N., Corso, P. J., Boyce, S. W., Pinto Slottow, T. L., ... Waksman, R. (2007). Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease. Circulation, 116(11 Suppl), pp. I200-6.
Javaid A, et al. Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-eluting Stents for Patients With Multivessel Coronary Artery Disease. Circulation. 2007 Sep 11;116(11 Suppl):I200-6. PubMed PMID: 17846304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease. AU - Javaid,Aamir, AU - Steinberg,Daniel H, AU - Buch,Ashesh N, AU - Corso,Paul J, AU - Boyce,Steven W, AU - Pinto Slottow,Tina L, AU - Roy,Probal K, AU - Hill,Peter, AU - Okabe,Teruo, AU - Torguson,Rebecca, AU - Smith,Kimberly A, AU - Xue,Zhenyi, AU - Gevorkian,Natalie, AU - Suddath,William O, AU - Kent,Kenneth M, AU - Satler,Lowell F, AU - Pichard,Augusto D, AU - Waksman,Ron, PY - 2007/9/14/pubmed PY - 2007/10/12/medline PY - 2007/9/14/entrez SP - I200 EP - 6 JF - Circulation JO - Circulation VL - 116 IS - 11 Suppl N2 - BACKGROUND: Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease. METHODS AND RESULTS: A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19). CONCLUSIONS: Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes. Coronary artery bypass surgery may be the preferred revascularization strategy in diabetic patients with multivessel coronary artery disease. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17846304/Outcomes_of_coronary_artery_bypass_grafting_versus_percutaneous_coronary_intervention_with_drug_eluting_stents_for_patients_with_multivessel_coronary_artery_disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.681148?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -