Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease
Topic: Cardiovascular Surgery

Study Question: What are the comparative rates of death, death or myocardial infarction, and subsequent revascularization in patients receiving drug-eluting stents (DES) and those undergoing coronary artery bypass grafting (CABG) in New York State?

Methods: The authors identified patients with multivessel disease who received DES or underwent CABG in New York State between October 2003 and December 2004 and compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 2005, after adjustment for differences in baseline risk factors among the patients.

Results: In comparison with treatment with a DES, 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], 0.65-0.97) and the adjusted survival rate was 94% versus 92.7% (p = 0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63-0.89) 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, 0.57-0.89) and the adjusted survival rate was 96% versus 94.6% (p = 0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59-0.87) and the adjusted rate of survival free of myocardial infarction was 94.5% versus 92.5% (p < 0.001). Patients undergoing CABG also had lower rates of repeat revascularization.

Conclusions: The authors concluded that for patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with DES, and is also associated with lower rates of death and myocardial infarction and repeat revascularization.

在多数冠状血管疾病中