Published Online
on April 14, 2008

A more recent version of this article appeared on April 22, 2008

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Submitted on November 2, 2007
Accepted on February 20, 2008

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, and 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.

^* To whom correspondence should be addressed. E-mail: sjpark{at}amc.seoul.kr.

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.

Key words: bypass • coronary disease • mortality • stents

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