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Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery.
Circulation 2016; 133(22):2132-40Circ

Abstract

BACKGROUND

Guidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials.

METHODS AND RESULTS

Patients with multivessel disease and severe left ventricular systolic dysfunction (ejection fraction ≤35%) who underwent either PCI with everolimus-eluting stent or CABG were selected from the New York State registries. The primary outcome was long-term all-cause death. Secondary outcomes were individual outcomes of myocardial infarction, stroke, and repeat revascularization. Among the 4616 patients who fulfilled our inclusion criteria (1351 everolimus-eluting stent and 3265 CABG), propensity score matching identified 2126 patients with similar propensity scores. In the short term, PCI was associated with a lower risk of stroke (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.01-0.39; P=0.004) in comparison with CABG. At long-term follow-up (median, 2.9 years), PCI was associated with a similar risk of death (HR, 1.01; 95% CI, 0.81-1.28; P=0.91), a higher risk of myocardial infarction (HR, 2.16; 95% CI, 1.42-3.28; P=0.0003), a lower risk of stroke (HR, 0.57; 95% CI, 0.33-0.97; P=0.04), and a higher risk of repeat revascularization (HR, 2.54; 95% CI, 1.88-3.44; P<0.0001). The test for interaction was significant (P=0.002) for completeness of revascularization, such that, in patients in whom complete revascularization was achieved with PCI, there was no difference in myocardial infarction between PCI and CABG.

CONCLUSIONS

Among patients with multivessel disease and severe left ventricular systolic dysfunction, PCI with everolimus-eluting stent had comparable long-term survival in comparison with CABG. PCI was associated with higher risk of myocardial infarction (in those with incomplete revascularization) and repeat revascularization, and CABG was associated with higher risk of stroke.

Authors+Show Affiliations

From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.). sripalbangalore@gmail.com.From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27151532

Citation

Bangalore, Sripal, et al. "Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery." Circulation, vol. 133, no. 22, 2016, pp. 2132-40.
Bangalore S, Guo Y, Samadashvili Z, et al. Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. Circulation. 2016;133(22):2132-40.
Bangalore, S., Guo, Y., Samadashvili, Z., Blecker, S., & Hannan, E. L. (2016). Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. Circulation, 133(22), pp. 2132-40. doi:10.1161/CIRCULATIONAHA.115.021168.
Bangalore S, et al. Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. Circulation. 2016 May 31;133(22):2132-40. PubMed PMID: 27151532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. AU - Bangalore,Sripal, AU - Guo,Yu, AU - Samadashvili,Zaza, AU - Blecker,Saul, AU - Hannan,Edward L, Y1 - 2016/05/05/ PY - 2015/12/23/received PY - 2016/03/28/accepted PY - 2016/5/7/entrez PY - 2016/5/7/pubmed PY - 2016/12/15/medline KW - coronary artery bypass KW - everolimus KW - percutaneous coronary intervention KW - ventricular dysfunction SP - 2132 EP - 40 JF - Circulation JO - Circulation VL - 133 IS - 22 N2 - BACKGROUND: Guidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials. METHODS AND RESULTS: Patients with multivessel disease and severe left ventricular systolic dysfunction (ejection fraction ≤35%) who underwent either PCI with everolimus-eluting stent or CABG were selected from the New York State registries. The primary outcome was long-term all-cause death. Secondary outcomes were individual outcomes of myocardial infarction, stroke, and repeat revascularization. Among the 4616 patients who fulfilled our inclusion criteria (1351 everolimus-eluting stent and 3265 CABG), propensity score matching identified 2126 patients with similar propensity scores. In the short term, PCI was associated with a lower risk of stroke (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.01-0.39; P=0.004) in comparison with CABG. At long-term follow-up (median, 2.9 years), PCI was associated with a similar risk of death (HR, 1.01; 95% CI, 0.81-1.28; P=0.91), a higher risk of myocardial infarction (HR, 2.16; 95% CI, 1.42-3.28; P=0.0003), a lower risk of stroke (HR, 0.57; 95% CI, 0.33-0.97; P=0.04), and a higher risk of repeat revascularization (HR, 2.54; 95% CI, 1.88-3.44; P<0.0001). The test for interaction was significant (P=0.002) for completeness of revascularization, such that, in patients in whom complete revascularization was achieved with PCI, there was no difference in myocardial infarction between PCI and CABG. CONCLUSIONS: Among patients with multivessel disease and severe left ventricular systolic dysfunction, PCI with everolimus-eluting stent had comparable long-term survival in comparison with CABG. PCI was associated with higher risk of myocardial infarction (in those with incomplete revascularization) and repeat revascularization, and CABG was associated with higher risk of stroke. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/27151532/Revascularization_in_Patients_With_Multivessel_Coronary_Artery_Disease_and_Severe_Left_Ventricular_Systolic_Dysfunction:_Everolimus_Eluting_Stents_Versus_Coronary_Artery_Bypass_Graft_Surgery_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.021168?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -