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Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome.
Am J Cardiol. 2017 Aug 01; 120(3):380-386.AJ

Abstract

There is limited data comparing effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). We compared the long-term outcomes of the 2 revascularization strategies in 1,246 patients presented with NSTE-ACS for left main or multivessel coronary artery disease. Data were pooled from the Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease (BEST) trial, the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) trial, and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. The primary outcome was a composite of death from any causes, myocardial infarction, or stroke. The baseline characteristics were similar between the 2 study groups. During the median follow-up of 60 months, the rate of the primary outcome was significantly lower with CABG than with PCI (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56 to 0.98; p = 0.036). This difference was mainly attributed to a significant reduction in the rate of myocardial infarction (HR 0.50; 95% CI 0.31 to 0.82, p = 0.006). The superiority of CABG over PCI was consistent across the major subgroups. The individual risks of death from any causes or stroke were not different between the 2 groups. In contrast, the rate of repeat revascularization was significantly lower in the CABG group than in the PCI group (HR 0.56; 95% CI 0.41 to 0.75, p <0.001). In this study, among patients with NSTE-ACS for left main or multivessel coronary artery disease, CABG significantly reduces the risk of death from any causes, myocardial infarction, or stroke compared with PCI with drug-eluting stents.

Authors+Show Affiliations

Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: cheolwlee@amc.seoul.kr.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Erasmus University Medical Center, Rotterdam, The Netherlands.Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.Erasmus University Medical Center, Rotterdam, The Netherlands.Division of Biostatistics, Asan Medical Center, University of Ulsan, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Erasmus University Medical Center, Rotterdam, The Netherlands; International Center for Circulatory Health, Imperial College of London, London, United Kingdom.Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

28595861

Citation

Chang, Mineok, et al. "Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome." The American Journal of Cardiology, vol. 120, no. 3, 2017, pp. 380-386.
Chang M, Lee CW, Ahn JM, et al. Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome. Am J Cardiol. 2017;120(3):380-386.
Chang, M., Lee, C. W., Ahn, J. M., Cavalcante, R., Sotomi, Y., Onuma, Y., Han, M., Park, D. W., Kang, S. J., Lee, S. W., Kim, Y. H., Park, S. W., Serruys, P. W., & Park, S. J. (2017). Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome. The American Journal of Cardiology, 120(3), 380-386. https://doi.org/10.1016/j.amjcard.2017.04.038
Chang M, et al. Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome. Am J Cardiol. 2017 Aug 1;120(3):380-386. PubMed PMID: 28595861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome. AU - Chang,Mineok, AU - Lee,Cheol Whan, AU - Ahn,Jung-Min, AU - Cavalcante,Rafael, AU - Sotomi,Yohei, AU - Onuma,Yoshinobu, 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, Y1 - 2017/05/10/ PY - 2017/01/08/received PY - 2017/04/27/revised PY - 2017/04/27/accepted PY - 2017/6/10/pubmed PY - 2017/8/17/medline PY - 2017/6/10/entrez SP - 380 EP - 386 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 120 IS - 3 N2 - There is limited data comparing effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). We compared the long-term outcomes of the 2 revascularization strategies in 1,246 patients presented with NSTE-ACS for left main or multivessel coronary artery disease. Data were pooled from the Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease (BEST) trial, the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) trial, and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. The primary outcome was a composite of death from any causes, myocardial infarction, or stroke. The baseline characteristics were similar between the 2 study groups. During the median follow-up of 60 months, the rate of the primary outcome was significantly lower with CABG than with PCI (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56 to 0.98; p = 0.036). This difference was mainly attributed to a significant reduction in the rate of myocardial infarction (HR 0.50; 95% CI 0.31 to 0.82, p = 0.006). The superiority of CABG over PCI was consistent across the major subgroups. The individual risks of death from any causes or stroke were not different between the 2 groups. In contrast, the rate of repeat revascularization was significantly lower in the CABG group than in the PCI group (HR 0.56; 95% CI 0.41 to 0.75, p <0.001). In this study, among patients with NSTE-ACS for left main or multivessel coronary artery disease, CABG significantly reduces the risk of death from any causes, myocardial infarction, or stroke compared with PCI with drug-eluting stents. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/28595861/Comparison_of_Outcome_of_Coronary_Artery_Bypass_Grafting_Versus_Drug_Eluting_Stent_Implantation_for_Non_ST_Elevation_Acute_Coronary_Syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(17)30773-7 DB - PRIME DP - Unbound Medicine ER -