Cheol Whan Lee1, Jung-Min Ahn1, Rafael Cavalcante2, Yohei Sotomi3, Yoshinobu Onuma2, Pannipa Suwannasom2, Erhan Tenekecioglu2, Sung-Cheol Yun4, Duk-Woo Park1, Soo-Jin Kang1, Seung-Whan Lee1, Young-Hak Kim1, Seong-Wook Park1, Patrick W Serruys5, Seung-Jung Park6. 1. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. Erasmus University Medical Center, Amsterdam, the Netherlands. 3. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4. Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 5. Erasmus University Medical Center, Amsterdam, the Netherlands; International Center for Circulatory Health, Imperial College London, London, United Kingdom. 6. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: sjpark@amc.seoul.kr.
Abstract
OBJECTIVES: The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD). BACKGROUND: The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial. METHODS: Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs. Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trials. The primary outcome was a composite of all-cause death, myocardial infarction, or stroke. RESULTS: The median follow-up was 60 months, and follow-up was completed for 96.2% of patients. The rate of primary outcome was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046). The difference was mainly driven by reduction in myocardial infarction (HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant interaction between treatment effect and types of CAD, showing CABG to be superior compared with PCI with DES in patients with multivessel CAD (p = 0.001), but no between-group difference in those with left main CAD (p = 0.427). The rates for all-cause death and stroke were similar between the 2 groups. By contrast, the need for repeat revascularization was significantly lower in the CABG group compared with the PCI group. CONCLUSIONS: CABG, as compared with PCI with DES, reduced long-term rates of the composite of all-cause death, myocardial infarction, or stroke in patients with left main or multivessel CAD. The advantage of CABG over PCI with DES was particularly pronounced in those with multivessel CAD.
OBJECTIVES: The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD). BACKGROUND: The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial. METHODS: Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs. Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trials. The primary outcome was a composite of all-cause death, myocardial infarction, or stroke. RESULTS: The median follow-up was 60 months, and follow-up was completed for 96.2% of patients. The rate of primary outcome was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046). The difference was mainly driven by reduction in myocardial infarction (HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant interaction between treatment effect and types of CAD, showing CABG to be superior compared with PCI with DES in patients with multivessel CAD (p = 0.001), but no between-group difference in those with left main CAD (p = 0.427). The rates for all-cause death and stroke were similar between the 2 groups. By contrast, the need for repeat revascularization was significantly lower in the CABG group compared with the PCI group. CONCLUSIONS: CABG, as compared with PCI with DES, reduced long-term rates of the composite of all-cause death, myocardial infarction, or stroke in patients with left main or multivessel CAD. The advantage of CABG over PCI with DES was particularly pronounced in those with multivessel CAD.
Authors: Adriana Silveira Almeida; Sandra C Fuchs; Felipe C Fuchs; Aline Gonçalves Silva; Marcelo Balbinot Lucca; Samuel Scopel; Flávio D Fuchs Journal: Vasc Health Risk Manag Date: 2020-07-16
Authors: Pedro José Negreiros de Andrade; João Luiz de Alencar Araripe Falcão; Breno de Alencar Araripe Falcão; Hermano Alexandre Lima Rocha Journal: Arq Bras Cardiol Date: 2019-02-21 Impact factor: 2.000
Authors: Xiao Ming Liu; Zuo Ming Yang; Xiao Kun Liu; Qi Zhang; Chang Qing Liu; Quan Le Han; Jian Hua Sun Journal: Anatol J Cardiol Date: 2019-02 Impact factor: 1.596