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Previous Volume 358:331-341 January 24, 2008 Number 4 Next

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ABSTRACT

Background Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents.

Methods We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients.

Results In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization.

Conclusions For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization.

Source Information

From the University at Albany, Albany, NY (E.L.H., C.W.); St. Joseph's Hospital, Syracuse, NY (G.W.); New York University Medical Center, New York (A.T.C.); Medical University of Ohio, Toledo (J.P.G.); Columbia–Presbyterian Medical Center, New York (C.R.S.); Rush University Medical Center, Chicago (R.S.D.H.); Mercy Hospital, Buffalo, NY (R.E.C.); and Duke University Medical Center, Durham, NC (R.H.J.).

Address reprint requests to Dr. Hannan at the Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York, University at Albany, 1 University Pl., Rensselaer, NY 12144-3456, or at elh03{at}health.state.ny.us.

Full Text of this Article

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• (2008). Revascularization for Multivessel Disease: CABG or PCI?. JWatch General 2008: 2-2 [Full Text]  
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• Carrozza, J. P. Jr. (2008). Drug-Eluting Stents -- Pushing the Envelope beyond the Labels?. NEJM 358: 405-407 [Full Text]  
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