FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Carrozza, J. P. 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 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

Related Letters:

Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting
Daemen J., Kukreja N., Serruys P. W., Abbate A., Lipinski M. J., Harjai K. J., Ng A. C.C., Kritharides L., Burack J. H., Hannan E. L.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2641-2644, Jun 12, 2008. Correspondence

This article has been cited by other articles:

• Kenney, K. M., Marzo, M. C., Ondrasik, N. R., Wisenbaugh, T. (2009). Percutaneous Coronary Intervention Outcomes in a Low-Volume Center: Survival, Stent Thrombosis, and Repeat Revascularization. Circ Cardiovasc Qual Outcomes 2: 671-677 [Abstract] [Full Text]  
• Bastarrika, G., Lee, Y. S., Huda, W., Ruzsics, B., Costello, P., Schoepf, U. J. (2009). CT of Coronary Artery Disease. Radiology 253: 317-338 [Abstract] [Full Text]  
• Hamilos, M., Muller, O., Cuisset, T., Ntalianis, A., Chlouverakis, G., Sarno, G., Nelis, O., Bartunek, J., Vanderheyden, M., Wyffels, E., Barbato, E., Heyndrickx, G. R., Wijns, W., De Bruyne, B. (2009). Long-Term Clinical Outcome After Fractional Flow Reserve-Guided Treatment in Patients With Angiographically Equivocal Left Main Coronary Artery Stenosis. Circulation 120: 1505-1512 [Abstract] [Full Text]  
• Falk, V. (2009). The 'real world' asks for coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 36: 609-610 [Full Text]  
• Benedetto, U., Melina, G., Angeloni, E., Refice, S., Roscitano, A., Fiorani, B., Di Nucci, G. D., Sinatra, R. (2009). Coronary artery bypass grafting versus drug-eluting stents in multivessel coronary disease. A meta-analysis on 24,268 patients. Eur. J. Cardiothorac. Surg. 36: 611-615 [Abstract] [Full Text]  
• Gulati, R., Rihal, C. S., Gersh, B. J. (2009). The SYNTAX Trial: A Perspective. Circ Cardiovasc Interv 2: 463-467 [Full Text]  
• McGinn, J. T. Jr, Usman, S., Lapierre, H., Pothula, V. R., Mesana, T. G., Ruel, M. (2009). Minimally Invasive Coronary Artery Bypass Grafting: Dual-Center Experience in 450 Consecutive Patients. Circulation 120: S78-S84 [Abstract] [Full Text]  
• O'Neill, W. W. (2009). A Case Against Low-Volume Percutaneous Coronary Intervention Centers. Circulation 120: 546-548 [Full Text]  
• Tran, H. A., Barnett, S. D., Hunt, S. L., Chon, A., Ad, N. (2009). The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus.. J. Thorac. Cardiovasc. Surg. 138: 316-323 [Abstract] [Full Text]  
• Gyongyosi, M., Christ, G., Lang, I., Kreiner, G., Sochor, H., Probst, P., Neunteufl, T., Badr-Eslam, R., Winkler, S., Nyolczas, N., Posa, A., Leisch, F., Karnik, R., Siostrzonek, P., Harb, S., Heigert, M., Zenker, G., Benzer, W., Bonner, G., Kaider, A., Glogar, D., on behalf of the AUTAX Investigators, (2009). 2-Year Results of the AUTAX (Austrian Multivessel TAXUS-Stent) Registry: Beyond the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) Study. J Am Coll Cardiol Intv 2: 718-727 [Abstract] [Full Text]  
• Wijns, W. (2009). The AUTAX (Austrian Multivessel TAXUS-Stent) Registry: Another Useful Registry on Stented Angioplasty for Multivessel Disease?. J Am Coll Cardiol Intv 2: 728-730 [Full Text]  
• Yap, C.-H., Yan, B. P., Akowuah, E., Dinh, D. T., Smith, J. A., Shardey, G. C., Tatoulis, J., Skillington, P. D., Newcomb, A., Mohajeri, M., Pick, A., Seevanayagam, S., Reid, C. M. (2009). Does Prior Percutaneous Coronary Intervention Adversely Affect Early and Mid-Term Survival After Coronary Artery Surgery?. J Am Coll Cardiol Intv 2: 758-764 [Abstract] [Full Text]  
• Yusuf, S., Natarajan, M., Karthikeyan, G., Taggart, D. (2009). Management of stable angina. BMJ 339: b2789-b2789 [Full Text]  
• Puskas, J. D., Halkos, M. E., Balkhy, H., Caskey, M., Connolly, M., Crouch, J., Diegeler, A., Gummert, J., Harringer, W., Subramanian, V., Sutter, F., Matschke, K., EPIC Trial Investigators, (2009). Evaluation of the PAS-Port Proximal Anastomosis System in coronary artery bypass surgery (the EPIC trial). J. Thorac. Cardiovasc. Surg. 138: 125-132 [Abstract] [Full Text]  
• Frutkin, A. D., Lindsey, J. B., Mehta, S. K., House, J. A., Spertus, J. A., Cohen, D. J., Rumsfeld, J. S., Marso, S. P., on behalf of the NCDR (National Cardiovascular Dat, (2009). Drug-Eluting Stents and the Use of Percutaneous Coronary Intervention Among Patients With Class I Indications for Coronary Artery Bypass Surgery Undergoing Index Revascularization: Analysis From the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol Intv 2: 614-621 [Abstract] [Full Text]  
• Kukreja, N, Serruys, P W, De Bruyne, B, Colombo, A, Macaya, C, Richardt, G, Fajadet, J, Hamm, C, Goedhart, D, Macours, N, Stoll, H P, on behalf of the ARTS-II Investigators, (2009). Sirolimus-eluting stents, bare metal stents or coronary artery bypass grafting for patients with multivessel disease including involvement of the proximal left anterior descending artery: analysis of the Arterial Revascularization Therapies study part 2 (ARTS-II). Heart 95: 1061-1066 [Abstract] [Full Text]  
• Adams, D. H., Anyanwu, A. C., Chikwe, J., Filsoufi, F. (2009). The Year in Cardiovascular Surgery. J Am Coll Cardiol 53: 2389-2403 [Full Text]  
• Dixon, S. R., Grines, C. L., O'Neill, W. W. (2009). The year in interventional cardiology.. J Am Coll Cardiol 53: 2080-2097 [Full Text]  
• Aldea, G. S., Mokadam, N. A., Melford, R. Jr, Stewart, D., Maynard, C., Reisman, M., Goss, R. (2009). Changing Volumes, Risk Profiles, and Outcomes of Coronary Artery Bypass Grafting and Percutaneous Coronary Interventions.. Ann. Thorac. Surg. 87: 1828-1838 [Abstract] [Full Text]  
• Smith, P. K. (2009). Treatment selection for coronary artery disease: the collision of a belief system with evidence.. Ann. Thorac. Surg. 87: 1328-1331 [Full Text]  
• Smith, P. K. (2009). Treatment selection for coronary artery disease: The collision of a belief system with evidence.. J. Thorac. Cardiovasc. Surg. 137: 1050-1053 [Full Text]  
• Hlatky, M. A., Heidenreich, P. A. (2009). The Year in Epidemiology, Health Services Research, and Outcomes Research. J Am Coll Cardiol 53: 1459-1466 [Full Text]  
• Li, Y., Zheng, Z., Xu, B., Zhang, S., Li, W., Gao, R., Hu, S. (2009). Comparison of Drug-Eluting Stents and Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Disease: Three-Year Follow-Up Results From a Single Institution. Circulation 119: 2040-2050 [Abstract] [Full Text]  
• Konstantinov, I. E., Saxena, P., Shehatha, J. (2009). Coronary stent disease: When will enough be enough?. J. Thorac. Cardiovasc. Surg. 137: 1020-1021 [Full Text]  
• Serruys, P. W., Morice, M.-C., Kappetein, A. P., Colombo, A., Holmes, D. R., Mack, M. J., Stahle, E., Feldman, T. E., van den Brand, M., Bass, E. J., Van Dyck, N., Leadley, K., Dawkins, K. D., Mohr, F. W., the SYNTAX Investigators, (2009). Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. NEJM 360: 961-972 [Abstract] [Full Text]  
• Lange, R. A., Hillis, L. D. (2009). Coronary Revascularization in Context. NEJM 360: 1024-1026 [Full Text]  
• Mutsuga, M., Narita, Y., Yamawaki, A., Satake, M., Kaneko, H., Suematsu, Y., Usui, A., Ueda, Y. (2009). A new strategy for prevention of anastomotic stricture using tacrolimus-eluting biodegradable nanofiber.. J. Thorac. Cardiovasc. Surg. 137: 703-709 [Abstract] [Full Text]  
• Smith, C. R. (2009). Surgery, Not Percutaneous Revascularization, Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis. Circulation 119: 1013-1020 [Full Text]  
• Teirstein, P. S. (2009). Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis. Circulation 119: 1021-1033 [Full Text]  
• Ryan, J., Linde-Zwirble, W., Engelhart, L., Cooper, L., Cohen, D. J. (2009). Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras: Results From the US Medicare Program. Circulation 119: 952-961 [Abstract] [Full Text]  
• Nevis, I. F., Mathew, A., Novick, R. J., Parikh, C. R., Devereaux, P. J., Natarajan, M. K., Iansavichus, A. V., Cuerden, M. S., Garg, A. X. (2009). Optimal Method of Coronary Revascularization in Patients Receiving Dialysis: Systematic Review. CJASN 4: 369-378 [Abstract] [Full Text]  
• Zhao, D. X., Leacche, M., Balaguer, J. M., Boudoulas, K. D., Damp, J. A., Greelish, J. P., Byrne, J. G., the Writing Group on behalf of the Cardiac Surgery, (2009). Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.. J Am Coll Cardiol 53: 232-241 [Abstract] [Full Text]  
• Tonino, P. A.L., De Bruyne, B., Pijls, N. H.J., Siebert, U., Ikeno, F., van `t Veer, M., Klauss, V., Manoharan, G., Engstrom, T., Oldroyd, K. G., Ver Lee, P. N., MacCarthy, P. A., Fearon, W. F., the FAME Study Investigators, (2009). Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention. NEJM 360: 213-224 [Abstract] [Full Text]  
• Loponen, P., Korpilahti, K., Luther, M., Huhtala, H., Tarkka, M. R. (2009). Repeat intervention after invasive treatment of coronary arteries. Eur. J. Cardiothorac. Surg. 35: 43-47 [Abstract] [Full Text]  
• Crea, F., Camici, P. G., De Caterina, R., Lanza, G. A. (2009). CHAPTER 17 Chronic Ischaemic Heart Disease. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full Text]  
• Holzhey, D. M., Jacobs, S., Mochalski, M., Merk, D., Walther, T., Mohr, F. W., Falk, V. (2008). Minimally Invasive Hybrid Coronary Artery Revascularization. Ann. Thorac. Surg. 86: 1856-1860 [Abstract] [Full Text]  
• Albacker, T. (2008). Invited Commentary. Ann. Thorac. Surg. 86: 1860-1860 [Full Text]  
• Byrne, J. G., Leacche, M., Vaughan, D. E., Zhao, D. X. (2008). Hybrid Cardiovascular Procedures. J Am Coll Cardiol Intv 1: 459-468 [Abstract] [Full Text]  
• Anstrom, K. J., Kong, D. F., Shaw, L. K., Califf, R. M., Kramer, J. M., Peterson, E. D., Rao, S. V., Matchar, D. B., Mark, D. B., Harrington, R. A., Eisenstein, E. L. (2008). Long-term Clinical Outcomes Following Coronary Stenting. Arch Intern Med 168: 1647-1655 [Abstract] [Full Text]  
• Holmes, D. R. Jr, Williams, D. O. (2008). Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future. Circ Cardiovasc Interv 1: 60-73 [Abstract] [Full Text]  
• Brar, S. S., Syros, G., Dangas, G. (2008). Multivessel Disease: Percutaneous Coronary Intervention for Classic Coronary Artery Bypass Grafting Indications. ANGIOLOGY 59: 83S-88S [Abstract]  
• Pocar, M., Donatelli, F., Moneta, A., Tomoda, H., Tayek, J. A., Arnold, J. R., Banning, A. P., Park, S.-J., Park, D.-W., Kim, Y.-H. (2008). Stents versus Bypass Grafting for Left Main Coronary Artery Disease. NEJM 359: 423-425 [Full Text]  
• Daemen, J., Kukreja, N., Serruys, P. W., Abbate, A., Lipinski, M. J., Harjai, K. J., Ng, A. C.C., Kritharides, L., Burack, J. H., Hannan, E. L. (2008). Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting. NEJM 358: 2641-2644 [Full Text]  
• Lytle, B. W. (2008). The Challenge of Left Main Stenosis. J Am Coll Cardiol Intv 1: 246-247 [Full Text]  
• (2008). Revascularization for Multivessel Disease: CABG or PCI?. JWatch General 2008: 2-2 [Full Text]  
• (2008). All you need to read in the other general journals. BMJ 336: 242-243 [Full Text]  
• Carrozza, J. P. Jr. (2008). Drug-Eluting Stents -- Pushing the Envelope beyond the Labels?. NEJM 358: 405-407 [Full Text]  
• (2008). Drug-Eluting Stents, Bare-Metal Stents, and Bypass Surgery. Journal Watch Cardiology 2008: 1-1 [Full Text]