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(Circulation. 2008;117:2079-2086.)
© 2008 American Heart Association, Inc.

Interventional Cardiology

Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery Disease

Duk-Woo Park, MD; Sung-Cheol Yun, PhD; Seung-Whan Lee, MD; Young-Hak Kim, MD; Cheol Whan Lee, MD; Myeong-Ki Hong, MD; Jae-Joong Kim, MD; Suk Jung Choo, MD; Hyun Song, MD; Cheol Hyun Chung, MD; Jae-Won Lee, MD; Seong-Wook Park, MD; Seung-Jung Park, MD

From the Divisions of Cardiology (D.-W.P., S.-W.L., Y.-H.K., C.W.L., M.-K.H., J.-J.K., S.-W.P., S.-J.P.) and Cardiac Surgery (S.J.C., H.S., C.H.C., J.-W.L.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to Dr Seung-Jung Park, Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea. E-mail sjpark{at}amc.seoul.kr

Received November 2, 2007; accepted February 20, 2008.

Background— Although previous studies have compared the treatment effects of percutaneous coronary intervention and coronary artery bypass grafting (CABG), the long-term outcomes beyond 1 year among patients with multivessel coronary artery disease who underwent percutaneous coronary intervention with drug-eluting stents (DES) or CABG have not been evaluated.

Methods and Results— Between January 2003 and December 2005, 3042 patients with multivessel disease underwent coronary implantation of DES (n=1547) or CABG (n=1495). The primary end point was all-cause mortality. In a crude analysis, the rate of long-term mortality was significantly higher in patients who underwent CABG than in those who underwent DES implantation (3-year unadjusted mortality rate, 7.0% for CABG versus 4.4% for percutaneous coronary intervention; P=0.01). However, after adjustment for baseline differences, the overall risks of death were similar among all patients (hazard ratio, 0.85; 95% confidence interval [CI], 0.56 to 1.30; P=0.45), diabetic patients (hazard ratio, 1.76; 95% CI, 0.82 to 3.78; P=0.15), and patients with compromised ventricular function (hazard ratio, 1.39; 95% CI, 0.41 to 4.65; P=0.60). In the anatomic subgroups, mortality benefit with DES implantation was noted in patients with 2-vessel disease with involvement of the nonproximal left anterior descending artery (hazard ratio, 0.23; 95% CI, 0.01 to 0.78; P=0.016). The rate of revascularization was significantly higher in the DES than in the CABG group (hazard ratio, 2.81; 95% CI, 2.11 to 3.75; P<0.001).

Conclusions— For the treatment of multivessel coronary artery disease, percutaneous coronary intervention with DES implantation showed equivalent long-term mortality as CABG.

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CLINICAL PERSPECTIVE

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