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(Circulation. 2007;116:I-200 – I-206.)
© 2007 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery Disease

Aamir Javaid, MD; Daniel H. Steinberg, MD; Ashesh N. Buch, MBChB; Paul J. Corso, MD; Steven W. Boyce, MD; Tina L. Pinto Slottow, MD; Probal K. Roy, MD; Peter Hill, MD; Teruo Okabe, MD; Rebecca Torguson, MPH; Kimberly A. Smith, BS; Zhenyi Xue, MS; Natalie Gevorkian, MD; William O. Suddath, MD; Kenneth M. Kent, MD; Lowell F. Satler, MD; Augusto D. Pichard, MD; Ron Waksman, MD

From the Department of Internal Medicine, Division of Cardiology (A.J., D.H.S., A.N.B., T.L.P.S., P.K.R., P.H., T.O., R.T., K.A.S., Z.X., N.G., W.O.S., K.M.K., L.F.S., A.D.P., R.W.), and the Department of Surgery, Division of Cardiac Surgery (P.J.C., S.W.B.), Washington Hospital Center, Washington, DC.

Correspondence to Ron Waksman, MD, Washington Hospital Center, 110 Irving St NW, Suite 4B-1, Washington, DC 20010. E-mail ron.waksman{at}medstar.net

Background— Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease.

Methods and Results— A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19).

Conclusions— Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes. Coronary artery bypass surgery may be the preferred revascularization strategy in diabetic patients with multivessel coronary artery disease.

Key Words: multivessel coronary artery disease • drug-eluting stent • coronary artery bypass grafting

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