BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG). METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting. RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD. CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.
BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG). METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting. RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD. CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: J Nucl Cardiol Date: 2015-02 Impact factor: 5.952
Authors: Robert H Jones; Harvey White; Eric J Velazquez; Linda K Shaw; Ricardo Pietrobon; Julio A Panza; Robert O Bonow; George Sopko; Christopher M O'Connor; Jean-Lucien Rouleau Journal: J Am Coll Cardiol Date: 2010-08-03 Impact factor: 24.094
Authors: William S Weintraub; Maria V Grau-Sepulveda; Jocelyn M Weiss; Sean M O'Brien; Eric D Peterson; Paul Kolm; Zugui Zhang; Lloyd W Klein; Richard E Shaw; Charles McKay; Laura L Ritzenthaler; Jeffrey J Popma; John C Messenger; David M Shahian; Frederick L Grover; John E Mayer; Cynthia M Shewan; Kirk N Garratt; Issam D Moussa; George D Dangas; Fred H Edwards Journal: N Engl J Med Date: 2012-03-27 Impact factor: 91.245
Authors: Fred H Edwards; David M Shahian; Maria V Grau-Sepulveda; Frederick L Grover; John E Mayer; Sean M O'Brien; Elizabeth DeLong; Eric D Peterson; Charles McKay; Richard E Shaw; Kirk N Garratt; George D Dangas; John Messenger; Lloyd W Klein; Jeffrey J Popma; William S Weintraub Journal: Ann Thorac Surg Date: 2014-04-26 Impact factor: 4.330
Authors: Kirkeith Lertsburapa; Alan W Ahlberg; Timothy M Bateman; Deborah Katten; Lyndy Volker; S James Cullom; Gary V Heller Journal: J Nucl Cardiol Date: 2008-09-12 Impact factor: 5.952
Authors: Julio A Panza; Eric J Velazquez; Lilin She; Peter K Smith; José C Nicolau; Roberto R Favaloro; Sinisa Gradinac; Lukasz Chrzanowski; Dorairaj Prabhakaran; Jonathan G Howlett; Marek Jasinski; James A Hill; Hanna Szwed; Robert Larbalestier; Patrice Desvigne-Nickens; Robert H Jones; Kerry L Lee; Jean L Rouleau Journal: J Am Coll Cardiol Date: 2014-08-12 Impact factor: 24.094