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Previous Volume 344:1117-1124 April 12, 2001 Number 15 Next

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ABSTRACT

Background The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease.

Methods A total of 1205 patients were randomly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique. The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year. The costs of hospital resources used were also determined.

Results At one year, there was no significant difference between the two groups in terms of the rates of death, stroke, or myocardial infarction. Among patients who survived without a stroke or a myocardial infarction, 16.8 percent of those in the stenting group underwent a second revascularization, as compared with 3.5 percent of those in the surgery group. The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery (P<0.001 by the log-rank test). The costs for the initial procedure were $4,212 less for patients assigned to stenting than for those assigned to bypass surgery, but this difference was reduced during follow-up because of the increased need for repeated revascularization; after one year, the net difference in favor of stenting was estimated to be $2,973 per patient.

Conclusions As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization.

Source Information

From the Academisch Ziekenhuis Rotterdam Dijkzigt, Rotterdam, the Netherlands (P.W.S., M.J.B.B., L.A.H.); Klinik fuer Herzchirurgie, Salzburg, Austria (F.U.), Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil (J.E.S., A.J.); Catharina Ziekenhuis, Eindhoven, the Netherlands (H.J.R.M.B., J.P.A.M.S.); Queen Elizabeth Hospital, Birmingham, United Kingdom (N.B., R.B.); Cardialysis, Rotterdam, the Netherlands (M.-A.M.M.); and the Institute for Medical Technology Assessment, Rotterdam, the Netherlands (B.A.H.).

Address reprint requests to Dr. Serruys at the Department of Interventional Cardiology Heart Center, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands, or at serruys{at}card.azr.nl.

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