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Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of Individual Patient Data.
JACC Cardiovasc Interv 2016; 9(24):2481-2489JC

Abstract

OBJECTIVES

The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD).

BACKGROUND

The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial.

METHODS

Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs. Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trials. The primary outcome was a composite of all-cause death, myocardial infarction, or stroke.

RESULTS

The median follow-up was 60 months, and follow-up was completed for 96.2% of patients. The rate of primary outcome was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046). The difference was mainly driven by reduction in myocardial infarction (HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant interaction between treatment effect and types of CAD, showing CABG to be superior compared with PCI with DES in patients with multivessel CAD (p = 0.001), but no between-group difference in those with left main CAD (p = 0.427). The rates for all-cause death and stroke were similar between the 2 groups. By contrast, the need for repeat revascularization was significantly lower in the CABG group compared with the PCI group.

CONCLUSIONS

CABG, as compared with PCI with DES, reduced long-term rates of the composite of all-cause death, myocardial infarction, or stroke in patients with left main or multivessel CAD. The advantage of CABG over PCI with DES was particularly pronounced in those with multivessel CAD.

Authors+Show Affiliations

Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.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.Erasmus University Medical Center, Amsterdam, the Netherlands.Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Erasmus University Medical Center, Amsterdam, the Netherlands; International Center for Circulatory Health, Imperial College London, London, United Kingdom.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: sjpark@amc.seoul.kr.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28007199

Citation

Lee, Cheol Whan, et al. "Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: a Meta-Analysis of Individual Patient Data." JACC. Cardiovascular Interventions, vol. 9, no. 24, 2016, pp. 2481-2489.
Lee CW, Ahn JM, Cavalcante R, et al. Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of Individual Patient Data. JACC Cardiovasc Interv. 2016;9(24):2481-2489.
Lee, C. W., Ahn, J. M., Cavalcante, R., Sotomi, Y., Onuma, Y., Suwannasom, P., ... Park, S. J. (2016). Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of Individual Patient Data. JACC. Cardiovascular Interventions, 9(24), pp. 2481-2489. doi:10.1016/j.jcin.2016.10.008.
Lee CW, et al. Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: a Meta-Analysis of Individual Patient Data. JACC Cardiovasc Interv. 2016 12 26;9(24):2481-2489. PubMed PMID: 28007199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of Individual Patient Data. AU - Lee,Cheol Whan, AU - Ahn,Jung-Min, AU - Cavalcante,Rafael, AU - Sotomi,Yohei, AU - Onuma,Yoshinobu, AU - Suwannasom,Pannipa, AU - Tenekecioglu,Erhan, AU - Yun,Sung-Cheol, 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 - 2016/07/18/received PY - 2016/10/03/revised PY - 2016/10/06/accepted PY - 2016/12/24/entrez PY - 2016/12/23/pubmed PY - 2017/10/27/medline KW - coronary artery bypass graft surgery KW - drug-eluting stent(s) KW - left main coronary artery disease KW - multivessel coronary artery disease SP - 2481 EP - 2489 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 9 IS - 24 N2 - OBJECTIVES: The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD). BACKGROUND: The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial. METHODS: Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs. Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trials. The primary outcome was a composite of all-cause death, myocardial infarction, or stroke. RESULTS: The median follow-up was 60 months, and follow-up was completed for 96.2% of patients. The rate of primary outcome was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046). The difference was mainly driven by reduction in myocardial infarction (HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant interaction between treatment effect and types of CAD, showing CABG to be superior compared with PCI with DES in patients with multivessel CAD (p = 0.001), but no between-group difference in those with left main CAD (p = 0.427). The rates for all-cause death and stroke were similar between the 2 groups. By contrast, the need for repeat revascularization was significantly lower in the CABG group compared with the PCI group. CONCLUSIONS: CABG, as compared with PCI with DES, reduced long-term rates of the composite of all-cause death, myocardial infarction, or stroke in patients with left main or multivessel CAD. The advantage of CABG over PCI with DES was particularly pronounced in those with multivessel CAD. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/28007199/Coronary_Artery_Bypass_Surgery_Versus_Drug_Eluting_Stent_Implantation_for_Left_Main_or_Multivessel_Coronary_Artery_Disease:_A_Meta_Analysis_of_Individual_Patient_Data_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(16)31773-3 DB - PRIME DP - Unbound Medicine ER -