BACKGROUND: Coronary artery bypass surgery (CABG) and percutaneous coronary intervention with stenting (PCI-S) are both safe and effective approaches for revascularization in patients with multivessel coronary artery disease. However, conflicting information exists when comparing the efficacy of the two methods. In this study, we examined the outcomes of major adverse cardiovascular events and death for subgroups of typical "real-world" patients undergoing coronary revascularization in the modern era. METHODS AND RESULTS: Patients were included if they were revascularized by CABG or PCI-S, had > or = 5 years of follow-up, and had > or = 2-vessel disease. Patients were followed for an average of 7.0+/-3.2 years for incidence of death and major adverse cardiovascular events (death, myocardial infarction, or repeat revascularization). Multivariate regression models were used to correct for standard cardiac risk factors including age, sex, hyperlipidemia, diabetes mellitus, family history of coronary artery disease, smoking, hypertension, heart failure, and renal failure. Subgroup analyses were also performed, stratified by age, sex, diabetes, ejection fraction, and history of PCI-S, CABG, or myocardial infarction. A total of 6369 patients (CABG 4581; PCI-S 1788) were included. Age averaged 66+/-10.9 years, 76% were male, and 26% were diabetic. Multivariate risk favored CABG over PCI-S for both death (hazard ratio 0.85; P=0.001) and major adverse cardiovascular events (hazard ratio 0.51; P<0.0001). A similar advantage with CABG was also found in most substrata, including diabetes. CONCLUSIONS: In this large observational study of patients undergoing revascularization for multivessel coronary artery disease, a long-term benefit was found, in relationship to both death and major adverse cardiovascular events, for CABG over PCI-S regardless of diabetic status or other stratifications.
BACKGROUND: Coronary artery bypass surgery (CABG) and percutaneous coronary intervention with stenting (PCI-S) are both safe and effective approaches for revascularization in patients with multivessel coronary artery disease. However, conflicting information exists when comparing the efficacy of the two methods. In this study, we examined the outcomes of major adverse cardiovascular events and death for subgroups of typical "real-world" patients undergoing coronary revascularization in the modern era. METHODS AND RESULTS:Patients were included if they were revascularized by CABG or PCI-S, had > or = 5 years of follow-up, and had > or = 2-vessel disease. Patients were followed for an average of 7.0+/-3.2 years for incidence of death and major adverse cardiovascular events (death, myocardial infarction, or repeat revascularization). Multivariate regression models were used to correct for standard cardiac risk factors including age, sex, hyperlipidemia, diabetes mellitus, family history of coronary artery disease, smoking, hypertension, heart failure, and renal failure. Subgroup analyses were also performed, stratified by age, sex, diabetes, ejection fraction, and history of PCI-S, CABG, or myocardial infarction. A total of 6369 patients (CABG 4581; PCI-S 1788) were included. Age averaged 66+/-10.9 years, 76% were male, and 26% were diabetic. Multivariate risk favored CABG over PCI-S for both death (hazard ratio 0.85; P=0.001) and major adverse cardiovascular events (hazard ratio 0.51; P<0.0001). A similar advantage with CABG was also found in most substrata, including diabetes. CONCLUSIONS: In this large observational study of patients undergoing revascularization for multivessel coronary artery disease, a long-term benefit was found, in relationship to both death and major adverse cardiovascular events, for CABG over PCI-S regardless of diabetic status or other stratifications.
Authors: S S Iyengar; T Nair; J S Hiremath; U Jadhav; V K Katyal; D Kumbla; I Sathyamurthy; R K Jain; M Srinivasan Journal: Indian Heart J Date: 2013-07-10
Authors: Chuntao Wu; Songyang Zhao; Andrew S Wechsler; Stephen Lahey; Gary Walford; Alfred T Culliford; Jeffrey P Gold; Craig R Smith; David R Holmes; Spencer B King; Robert S D Higgins; Desmond Jordan; Edward L Hannan Journal: Ann Thorac Surg Date: 2011-10-19 Impact factor: 4.330
Authors: Peter Olson; Michael Cinelli; Hamfreth S Rahming; Thomas Vazzana; Jonathan Spagnola; Emad Barsoum; Marc Assaad; Frank Tamburrino; James Lafferty Journal: Cureus Date: 2022-06-06
Authors: Chuntao Wu; Fabian T Camacho; Songyang Zhao; Andrew S Wechsler; Alfred T Culliford; Stephen J Lahey; Spencer B King; Gary Walford; Jeffrey P Gold; Craig R Smith; Desmond Jordan; Robert S D Higgins; Edward L Hannan Journal: Ann Thorac Surg Date: 2013-02-04 Impact factor: 4.330
Authors: Jimmy T Efird; Wesley T O'Neal; Stephen W Davies; Whitney L Kennedy; Lada N Alger; Jason B O'Neal; T Bruce Ferguson; Alan P Kypson Journal: Br J Med Med Res Date: 2013-10