Tags

Type your tag names separated by a space and hit enter

Everolimus-eluting stents or bypass surgery for multivessel coronary disease.
N Engl J Med 2015; 372(13):1213-22NEJM

Abstract

BACKGROUND

Results of trials and registry studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. These previous analyses did not evaluate PCI with second-generation drug-eluting stents.

METHODS

In an observational registry study, we compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.

RESULTS

Among 34,819 eligible patients, 9223 patients who underwent PCI with everolimus-eluting stents and 9223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93 to 1.17; P=0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29 to 1.77; P<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14 to 2.58; P<0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization but was significant among those with incomplete revascularization (P=0.02 for interaction).

CONCLUSIONS

In a contemporary clinical-practice registry study, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but a lower risk of stroke. (Funded by Abbott Vascular.).

Authors+Show Affiliations

From New York University School of Medicine, New York (S. Bangalore, Y.G., S. Blecker, J.X.); and the School of Public Health, State University of New York at Albany, Albany (Z.S., E.L.H.).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25775087

Citation

Bangalore, Sripal, et al. "Everolimus-eluting Stents or Bypass Surgery for Multivessel Coronary Disease." The New England Journal of Medicine, vol. 372, no. 13, 2015, pp. 1213-22.
Bangalore S, Guo Y, Samadashvili Z, et al. Everolimus-eluting stents or bypass surgery for multivessel coronary disease. N Engl J Med. 2015;372(13):1213-22.
Bangalore, S., Guo, Y., Samadashvili, Z., Blecker, S., Xu, J., & Hannan, E. L. (2015). Everolimus-eluting stents or bypass surgery for multivessel coronary disease. The New England Journal of Medicine, 372(13), pp. 1213-22. doi:10.1056/NEJMoa1412168.
Bangalore S, et al. Everolimus-eluting Stents or Bypass Surgery for Multivessel Coronary Disease. N Engl J Med. 2015 Mar 26;372(13):1213-22. PubMed PMID: 25775087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Everolimus-eluting stents or bypass surgery for multivessel coronary disease. AU - Bangalore,Sripal, AU - Guo,Yu, AU - Samadashvili,Zaza, AU - Blecker,Saul, AU - Xu,Jinfeng, AU - Hannan,Edward L, Y1 - 2015/03/16/ PY - 2015/3/17/entrez PY - 2015/3/17/pubmed PY - 2015/4/4/medline SP - 1213 EP - 22 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 372 IS - 13 N2 - BACKGROUND: Results of trials and registry studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. These previous analyses did not evaluate PCI with second-generation drug-eluting stents. METHODS: In an observational registry study, we compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS: Among 34,819 eligible patients, 9223 patients who underwent PCI with everolimus-eluting stents and 9223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93 to 1.17; P=0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29 to 1.77; P<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14 to 2.58; P<0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization but was significant among those with incomplete revascularization (P=0.02 for interaction). CONCLUSIONS: In a contemporary clinical-practice registry study, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but a lower risk of stroke. (Funded by Abbott Vascular.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/25775087/Everolimus_eluting_stents_or_bypass_surgery_for_multivessel_coronary_disease_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa1412168?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -