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Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction.
Am J Cardiol 2017; 120(1):69-74AJ

Abstract

The optimal revascularization strategy for patients with significant coronary artery disease (CAD) and severe left ventricular (LV) dysfunction (ejection fraction ≤35%) remains unclear. We compared the effects of coronary artery bypass surgery (CABG, n = 442) versus percutaneous coronary intervention (PCI) with drug-eluting stents (n = 469) on long-term mortality in 911 patients with significant CAD and severe LV dysfunction using large real-world registry data. Databases of 3 real-world registries were merged for a patient-level meta-analysis. Primary outcome was death from any cause; secondary outcomes were death from cardiac causes, myocardial infarction, stroke, or repeat revascularization. At a median follow-up of 37.3 months, the risk of all-cause death (adjusted hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.31 to 0.61; p <0.001) was significantly lower in the CABG group than in the PCI group after adjustment. Similar findings were observed with regard to the risks of death from cardiac cause (adjusted HR 0.49; 95% CI 0.33 to 0.73; p <0.001) and repeat revascularization (adjusted HR 0.08; 95% CI 0.03 to 0.20; p <0.001). However, there were no significant differences in the risks of myocardial infarction and stroke between the 2 groups. The superiority of CABG over PCI was particularly pronounced in patients receiving β blockers and angiotensin-converting enzyme inhibitor or angiotensin receptor blockers than those who are not. In conclusion, among patients with significant CAD and severe LV dysfunction, CABG showed a lower risk of all-cause death, cardiac-cause death, and repeat revascularization compared with PCI with drug-eluting stents.

Authors+Show Affiliations

Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: cheolwlee@amc.seoul.k.Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28483202

Citation

Kang, Se Hun, et al. "Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction." The American Journal of Cardiology, vol. 120, no. 1, 2017, pp. 69-74.
Kang SH, Lee CW, Baek S, et al. Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction. Am J Cardiol. 2017;120(1):69-74.
Kang, S. H., Lee, C. W., Baek, S., Lee, P. H., Ahn, J. M., Park, D. W., ... Park, S. J. (2017). Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction. The American Journal of Cardiology, 120(1), pp. 69-74. doi:10.1016/j.amjcard.2017.03.261.
Kang SH, et al. Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction. Am J Cardiol. 2017 07 1;120(1):69-74. PubMed PMID: 28483202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular Dysfunction. AU - Kang,Se Hun, AU - Lee,Cheol Whan, AU - Baek,Seunghee, AU - Lee,Pil Hyung, AU - Ahn,Jung-Min, AU - Park,Duk-Woo, AU - Kang,Soo-Jin, AU - Lee,Seung-Whan, AU - Kim,Young-Hak, AU - Park,Seong-Wook, AU - Park,Seung-Jung, Y1 - 2017/04/12/ PY - 2016/12/29/received PY - 2017/03/24/revised PY - 2017/03/24/accepted PY - 2017/5/10/pubmed PY - 2017/8/10/medline PY - 2017/5/10/entrez SP - 69 EP - 74 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 120 IS - 1 N2 - The optimal revascularization strategy for patients with significant coronary artery disease (CAD) and severe left ventricular (LV) dysfunction (ejection fraction ≤35%) remains unclear. We compared the effects of coronary artery bypass surgery (CABG, n = 442) versus percutaneous coronary intervention (PCI) with drug-eluting stents (n = 469) on long-term mortality in 911 patients with significant CAD and severe LV dysfunction using large real-world registry data. Databases of 3 real-world registries were merged for a patient-level meta-analysis. Primary outcome was death from any cause; secondary outcomes were death from cardiac causes, myocardial infarction, stroke, or repeat revascularization. At a median follow-up of 37.3 months, the risk of all-cause death (adjusted hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.31 to 0.61; p <0.001) was significantly lower in the CABG group than in the PCI group after adjustment. Similar findings were observed with regard to the risks of death from cardiac cause (adjusted HR 0.49; 95% CI 0.33 to 0.73; p <0.001) and repeat revascularization (adjusted HR 0.08; 95% CI 0.03 to 0.20; p <0.001). However, there were no significant differences in the risks of myocardial infarction and stroke between the 2 groups. The superiority of CABG over PCI was particularly pronounced in patients receiving β blockers and angiotensin-converting enzyme inhibitor or angiotensin receptor blockers than those who are not. In conclusion, among patients with significant CAD and severe LV dysfunction, CABG showed a lower risk of all-cause death, cardiac-cause death, and repeat revascularization compared with PCI with drug-eluting stents. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/28483202/Comparison_of_Outcomes_of_Coronary_Artery_Bypass_Grafting_Versus_Drug_Eluting_Stent_Implantation_in_Patients_With_Severe_Left_Ventricular_Dysfunction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(17)30632-X DB - PRIME DP - Unbound Medicine ER -