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(Circulation. 2009;119:2040-2050.)
© 2009 American Heart Association, Inc.

Coronary Heart Disease

Comparison of Drug-Eluting Stents and Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Disease

Three-Year Follow-Up Results From a Single Institution

Yan Li, MD^*; Zhe Zheng, MD, PhD^*; Bo Xu, MD^*; Shiju Zhang, MD, PhD; Wei Li, PhD; Runlin Gao, MD, PhD; Shengshou Hu, MD, PhD

From the Departments of Cardiovascular Surgery (Y.L., S.H.) and Cardiology (B.X., R.G.), Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences; Department of Biostatistics, National Center for Cardiovascular Disease (W.L.); and Key Laboratory of Cardiovascular Regenerative Medicine, Ministry of Health (Z.Z., S.Z.), Beijing, China.

Correspondence to Shengshou Hu, MD, PhD, Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Beijing, China 100037. E-mail huss{at}vip.sohu.com or fuwai8359@126.com

Received September 5, 2008; accepted February 17, 2009.

Background— Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003, drug-eluting stents were introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery. The long-term outcome of drug-eluting stents compared with that of CABG surgery is also unclear.

Methods and Results— We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularization) during a 3-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients receiving drug-eluting stents had considerably higher 3-year rates of target-vessel revascularization. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the 2 groups (hazard ratio, 0.92; 95% confidence interval, 0.69 to 1.51).

Conclusions— In a cohort of patients with multivessel disease, CABG was associated with lower rates of death, myocardial infarction, and target-vessel revascularization than drug-eluting stents.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 119: 2017-2019. [Extract] [Full Text]