on April 26, 2004
Circulation. 2004
Published online before print April 26, 2004, doi: 10.1161/01.CIR.0000126826.58526.14
Published online before print April 26, 2004, doi: 10.1161/01.CIR.0000126826.58526.14
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Submitted on August 8, 2003
From the Departments of Cardiovascular Medicine (S.J.B., I.P.C., J.P.S., E.J.T., M.S.L.) and Cardiothoracic Surgery (B.W.L.), Cleveland Clinic Foundation, Cleveland, Ohio. * To whom correspondence should be addressed. E-mail: breners{at}ccf.org.
Background--Although most randomized clinical trials have suggested that long-term survival rates after percutaneous coronary intervention (PCI) or surgical multivessel coronary revascularization (CABG) are equivalent, some post hoc analyses in high-risk groups and adjustment for severity of coronary disease have suggested higher mortality after PCI. Methods and Results--We studied 6033 consecutive patients who underwent revascularization in the late 1990s. PCI was performed in 872 patients; 5161 underwent CABG. Half the patients had significant left ventricular dysfunction or diabetes. Propensity analysis to predict the probability of undergoing PCI according to 22 variables and their interactions was used. The C-statistic for this model was 0.90, indicating excellent discrimination between treatments. There were 931 deaths during 5 years of follow-up. The 1- and 5-year unadjusted mortality rates were 5% and 16% for PCI and 4% and 14% for CABG (unadjusted hazard ratio, 1.13; 95% CI, 1.0 to 1.4; P=0.07). PCI was associated with an increased risk of death (propensity-adjusted hazard ratio, 2.3; 95% CI, 1.9 to 2.9; P<0.0001). This difference was observed across all categories of propensity for PCI and in patients with diabetes or left ventricular dysfunction. Other independent predictors of mortality (P Conclusions--In patients with multivessel coronary artery disease and many high-risk characteristics, CABG was associated with better survival than PCI after adjustment for risk profile.
Revised on February 3, 2004
Accepted on February 6, 2004
Propensity Analysis of Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease and High-Risk Features
Sorin J. Brener MD*,
0.01 for all) were renal dysfunction, age, diabetes mellitus, chronic lung disease, peripheral vascular disease, left main trunk stenosis, and extent of coronary disease (Duke angiographic score).
Key words: angioplasty • bypass surgery • coronary disease • survival
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|
|
|
|
|
|
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|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 R. M. Califf Stenting or Surgery: An Opportunity to Do it Right J. Am. Coll. Cardiol., August 16, 2005; 46(4): 589 - 591. [Full Text] [PDF]
|
|
|
|
|
|
N. Mercado, W. Wijns, P. W. Serruys, U. Sigwart, M. D. Flather, R. H. Stables, W. W. O'Neill, A. Rodriguez, P. A. Lemos, W. A. Hueb, et al. One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trials J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 512 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]
|
|
|
|
|
|
D. P Taggart Surgery is the best intervention for severe coronary artery disease BMJ, April 2, 2005; 330(7494): 785 - 786. [Full Text] [PDF]
|
|
|
|
|
|
V. A. Starnes Presidential address: An evolving discipline J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 483 - 487. [Full Text] [PDF]
|
|
|
|
|
|
F. Beyersdorf Symposium for the Future of Cardiac Surgery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S2 - S3. [Full Text] [PDF]
|
|
|
|
 |
|
 PCI vs. CABG in High-Risk Patients with Multivessel CAD Journal Watch (General), June 22, 2004; 2004(622): 6 - 6. [Full Text]
|
|
|
|
|
|
R. SoRelle Cardiovascular News Circulation, May 18, 2004; 109(19): e9043 - e9044. [Full Text]
|
|