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Previous Volume 352:2174-2183 May 26, 2005 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Gersh, B. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Several studies have compared outcomes for coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), but most were done before the availability of stenting, which has revolutionized the latter approach.

Methods We used New York's cardiac registries to identify 37,212 patients with multivessel disease who underwent CABG and 22,102 patients with multivessel disease who underwent PCI from January 1, 1997, to December 31, 2000. We determined the rates of death and subsequent revascularization within three years after the procedure in various groups of patients according to the number of diseased vessels and the presence or absence of involvement of the left anterior descending coronary artery. The rates of adverse outcomes were adjusted by means of proportional-hazards methods to account for differences in patients' severity of illness before revascularization.

Results Risk-adjusted survival rates were significantly higher among patients who underwent CABG than among those who received a stent in all of the anatomical subgroups studied. For example, the adjusted hazard ratio for the long-term risk of death after CABG relative to stent implantation was 0.64 (95 percent confidence interval, 0.56 to 0.74) for patients with three-vessel disease with involvement of the proximal left anterior descending coronary artery and 0.76 (95 percent confidence interval, 0.60 to 0.96) for patients with two-vessel disease with involvement of the nonproximal left anterior descending coronary artery. Also, the three-year rates of revascularization were considerably higher in the stenting group than in the CABG group (7.8 percent vs. 0.3 percent for subsequent CABG and 27.3 percent vs. 4.6 percent for subsequent PCI).

Conclusions For patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting.

Source Information

From the University at Albany, State University of New York, Albany (E.L.H., M.J.R.); St. Joseph's Hospital, Syracuse, N.Y. (G.W.); Duke University Medical Center, Durham, N.C. (R.H.J.); Boston University School of Medicine, Boston (T.J.R.); St. Peter's Hospital, Albany, N.Y. (E.B.); New York University Medical Center, New York (A.T.C.); New York Hospital–Weill Cornell Medical Center, New York (O.W.I.); Montefiore Medical Center, Bronx, N.Y. (J.P.G.); and Columbia–Presbyterian Medical Center, New York (E.A.R.).

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Extract | Full Text | PDF  
N Engl J Med 2005; 353:735-737, Aug 18, 2005. Correspondence

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