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(Circulation. 2005;112:I-371 – I-376.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Comparing Long-Term Survival of Patients With Multivessel Coronary Disease After CABG or PCI

Analysis of BARI-Like Patients in Northern New England

David J. Malenka, MD; Bruce J. Leavitt, MD; Michael J. Hearne, MD; John F. Robb, MD; Yvon R. Baribeau, MD; Thomas J. Ryan, MD; Robert E. Helm, MD; Mirle A. Kellett, MD; Harold L. Dauerman, MD; Lawrence J. Dacey, MD, MS; M. Theodore Silver, MD; Peter N. VerLee, MD; Paul W. Weldner, MD; Bruce D. Hettleman, MD; Elaine M. Olmstead, MS; Winthrop D. Piper, MS; Gerald T. O’Connor, PhD, DSc, for the Northern New England Cardiovascular Disease Study Group

From the Section of Cardiology (D.J.M., J.F.R., B.D.H.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; the Center for the Evaluative Clinical Sciences (D.J.M., G.T.O.), Dartmouth Medical School, Hanover, NH; the Section of Cardiothoracic Surgery (B.J.L.), Fletcher Allen Health Care, Burlington, Vt; Catholic Medical Center (M.J.H., Y.R.B.), Manchester, NH; Maine Medical Center (T.J.R., M.A.K., P.W.W.), Portland, Me; Portsmouth Regional Hospital (R.E.H.), Portsmouth, NH; the Section of Cardiology (H.L.D.), Fletcher Allen Health Care, Burlington, Vt; the Section of Cardiothoracic Surgery (L.J.D.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Eastern Maine Medical Center (M.T.S., P.N.V.), Bangor, Me; and the Section of Clinical Research (E.M.O., W.D.P., G.T.O.), Dartmouth Medical School, Hanover, NH.

Correspondence to David J. Malenka, MD, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756. E-mail David.Malenka{at}Hitchcock.org

Background— Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice.

Methods and Results— From our northern New England registries of consecutive coronary revascularizations, we identified 10 198 CABG and 4295 PCI patients with MVD who may have been eligible for either procedure between 1994 and 2001. Vital status was obtained by linkage to the National Death Index. Proportional-hazards regression was used to calculate hazard ratios (HRs) for survival in CABG vs PCI patients after adjustment for comorbidities and disease characteristics. CABG patients were older; had more comorbidities, more 3-vessel disease, and lower ejection fractions; and were more completely revascularized. Adjusted long-term survival for patients with 3-vessel disease was better after CABG than PCI (HR, 0.60; P<0.01) but not for patients with 2-vessel disease (HR, 0.98; P=0.77). The survival advantage of CABG for 3-vessel disease patients was present in all patient populations, including women, diabetics, and the elderly and in the era of high stent utilization.

Conclusions— In contemporary practice, survival for patients with 3-vessel coronary disease is better after CABG than PCI, an observation that patients and physicians should carefully consider when deciding on a revascularization strategy.

Key Words: angioplasty • bypass • prognosis • revascularization • survival

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