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Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
N Engl J Med. 2008 Jan 24; 358(4):331-41.NEJM

Abstract

BACKGROUND

Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents.

METHODS

We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients.

RESULTS

In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization.

CONCLUSIONS

For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization.

Authors+Show Affiliations

Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, NY 12144-3456, USA. elh03@health.state.ny.usNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18216353

Citation

Hannan, Edward L., et al. "Drug-eluting Stents Vs. Coronary-artery Bypass Grafting in Multivessel Coronary Disease." The New England Journal of Medicine, vol. 358, no. 4, 2008, pp. 331-41.
Hannan EL, Wu C, Walford G, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358(4):331-41.
Hannan, E. L., Wu, C., Walford, G., Culliford, A. T., Gold, J. P., Smith, C. R., Higgins, R. S., Carlson, R. E., & Jones, R. H. (2008). Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. The New England Journal of Medicine, 358(4), 331-41. https://doi.org/10.1056/NEJMoa071804
Hannan EL, et al. Drug-eluting Stents Vs. Coronary-artery Bypass Grafting in Multivessel Coronary Disease. N Engl J Med. 2008 Jan 24;358(4):331-41. PubMed PMID: 18216353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. AU - Hannan,Edward L, AU - Wu,Chuntao, AU - Walford,Gary, AU - Culliford,Alfred T, AU - Gold,Jeffrey P, AU - Smith,Craig R, AU - Higgins,Robert S D, AU - Carlson,Russell E, AU - Jones,Robert H, PY - 2008/1/25/pubmed PY - 2008/1/30/medline PY - 2008/1/25/entrez SP - 331 EP - 41 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 358 IS - 4 N2 - BACKGROUND: Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents. METHODS: We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients. RESULTS: In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization. CONCLUSIONS: For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/18216353/Drug_eluting_stents_vs__coronary_artery_bypass_grafting_in_multivessel_coronary_disease_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa071804?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -