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Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease.
J Am Coll Cardiol 2016; 68(1):29-36JACC

Abstract

BACKGROUND

In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients.

OBJECTIVES

This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD.

METHODS

Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause.

RESULTS

The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001).

CONCLUSIONS

CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

27364047

Citation

Chang, Mineok, et al. "Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease." Journal of the American College of Cardiology, vol. 68, no. 1, 2016, pp. 29-36.
Chang M, Ahn JM, Lee CW, et al. Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease. J Am Coll Cardiol. 2016;68(1):29-36.
Chang, M., Ahn, J. M., Lee, C. W., Cavalcante, R., Sotomi, Y., Onuma, Y., ... Park, S. J. (2016). Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease. Journal of the American College of Cardiology, 68(1), pp. 29-36. doi:10.1016/j.jacc.2016.04.034.
Chang M, et al. Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease. J Am Coll Cardiol. 2016 07 5;68(1):29-36. PubMed PMID: 27364047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease. AU - Chang,Mineok, AU - Ahn,Jung-Min, AU - Lee,Cheol Whan, AU - Cavalcante,Rafael, AU - Sotomi,Yohei, AU - Onuma,Yoshinobu, AU - Tenekecioglu,Erhan, AU - Han,Minkyu, 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, PY - 2016/02/22/received PY - 2016/04/05/revised PY - 2016/04/06/accepted PY - 2016/7/2/entrez PY - 2016/7/2/pubmed PY - 2017/6/27/medline KW - coronary artery bypass graft surgery KW - drug-eluting stents KW - multivessel coronary artery disease SP - 29 EP - 36 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 68 IS - 1 N2 - BACKGROUND: In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients. OBJECTIVES: This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD. METHODS: Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause. RESULTS: The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001). CONCLUSIONS: CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/27364047/Long_Term_Mortality_After_Coronary_Revascularization_in_Nondiabetic_Patients_With_Multivessel_Disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(16)32991-6 DB - PRIME DP - Unbound Medicine ER -