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Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction.
Am J Cardiol 2016; 118(1):17-22AJ

Abstract

Patients with previous myocardial infarction (MI) have a high risk of recurrence. Little is known about the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with a previous MI and left main or multivessel coronary artery disease (CAD). We compared long-term outcomes of these 2 strategies in 672 patients with previous MI and left main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n = 323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was analyzed, and the primary outcome was a composite of death from any causes, MI, or stroke. Baseline characteristics were similar between the 2 groups. The median follow-up duration was 59.8 months. The rate of the primary outcome was significantly lower with CABG than PCI (hazard ratio [HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p <0.001). The benefit of CABG over PCI was consistent across all major subgroups. The individual risks of death from any causes or stroke were comparable between the 2 groups. Conversely, the rate of repeat revascularization was significantly lower with CABG than PCI (HR 0.34, 95% CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous MI and left main or multivessel CAD, compared to PCI with DES, CABG significantly reduces the risk of death from any causes, MI, or stroke.

Authors+Show Affiliations

Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: cheolwlee@amc.seoul.kr.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; International Center for Circulatory Health, Imperial College of London, London, United Kingdom.Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

27181565

Citation

Chang, Mineok, et al. "Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction." The American Journal of Cardiology, vol. 118, no. 1, 2016, pp. 17-22.
Chang M, Lee CW, Ahn JM, et al. Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction. Am J Cardiol. 2016;118(1):17-22.
Chang, M., Lee, C. W., Ahn, J. M., Cavalcante, R., Sotomi, Y., Onuma, Y., ... Park, S. J. (2016). Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction. The American Journal of Cardiology, 118(1), pp. 17-22. doi:10.1016/j.amjcard.2016.04.009.
Chang M, et al. Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction. Am J Cardiol. 2016 Jul 1;118(1):17-22. PubMed PMID: 27181565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction. AU - Chang,Mineok, AU - Lee,Cheol Whan, AU - Ahn,Jung-Min, AU - Cavalcante,Rafael, AU - Sotomi,Yohei, AU - Onuma,Yoshinobu, AU - Zeng,Yaping, AU - Park,Duk-Woo, AU - Kang,Soo-Jin, AU - Lee,Seung-Whan, AU - Kim,Young-Hak, AU - Park,Seong-Wook, AU - Serruys,Patrick W, AU - Park,Seung-Jung, Y1 - 2016/04/21/ PY - 2016/01/13/received PY - 2016/04/06/revised PY - 2016/04/06/accepted PY - 2016/5/17/entrez PY - 2016/5/18/pubmed PY - 2017/5/2/medline SP - 17 EP - 22 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 118 IS - 1 N2 - Patients with previous myocardial infarction (MI) have a high risk of recurrence. Little is known about the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with a previous MI and left main or multivessel coronary artery disease (CAD). We compared long-term outcomes of these 2 strategies in 672 patients with previous MI and left main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n = 323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was analyzed, and the primary outcome was a composite of death from any causes, MI, or stroke. Baseline characteristics were similar between the 2 groups. The median follow-up duration was 59.8 months. The rate of the primary outcome was significantly lower with CABG than PCI (hazard ratio [HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p <0.001). The benefit of CABG over PCI was consistent across all major subgroups. The individual risks of death from any causes or stroke were comparable between the 2 groups. Conversely, the rate of repeat revascularization was significantly lower with CABG than PCI (HR 0.34, 95% CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous MI and left main or multivessel CAD, compared to PCI with DES, CABG significantly reduces the risk of death from any causes, MI, or stroke. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/27181565/Coronary_Artery_Bypass_Grafting_Versus_Drug_Eluting_Stents_Implantation_for_Previous_Myocardial_Infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(16)30490-8 DB - PRIME DP - Unbound Medicine ER -