Mineok Chang1, Jung-Min Ahn1, Cheol Whan Lee2, Rafael Cavalcante3, Yohei Sotomi4, Yoshinobu Onuma3, Erhan Tenekecioglu3, Minkyu Han5, Duk-Woo Park1, Soo-Jin Kang1, Seung-Whan Lee1, Young-Hak Kim1, Seong-Wook Park1, Patrick W Serruys6, Seung-Jung Park1. 1. Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. 2. Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. Electronic address: cheolwlee@amc.seoul.kr. 3. Erasmus University Medical Center, Amsterdam, the Netherlands. 4. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 5. Division of Biostatistics, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. 6. Erasmus University Medical Center, Amsterdam, the Netherlands; International Center for Circulatory Health, Imperial College of London, London, United Kingdom.
Abstract
BACKGROUND: In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients. OBJECTIVES: This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD. METHODS: Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause. RESULTS: The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001). CONCLUSIONS: CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.
BACKGROUND: In diabeticpatients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabeticpatients. OBJECTIVES: This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabeticpatients with multivessel CAD. METHODS: Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause. RESULTS: The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001). CONCLUSIONS: CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabeticpatients with multivessel CAD.