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Published on: May 14, 2013
Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease
Edward L Hannan1, Chuntao Wu, Gary Walford
1Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, NY 12144-3456, USA. elh03@health.state.ny.us
Insights
Coronary-artery bypass grafting (CABG) shows better outcomes than drug-eluting stents for multivessel coronary artery disease. CABG is linked to lower death and myocardial infarction rates, and fewer repeat revascularizations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Comparative effectiveness of coronary-artery bypass grafting (CABG) and coronary stenting for multivessel coronary artery disease has been extensively studied.
- Limited data existed regarding outcomes after the introduction of drug-eluting stents (DES).
Purpose of the Study:
- To compare the safety and efficacy of CABG versus DES in patients with multivessel coronary artery disease.
- To evaluate adverse outcomes including mortality, myocardial infarction, and repeat revascularization.
Main Methods:
- Retrospective analysis of patients with multivessel disease in New York State from October 2003 to December 2004.
- Comparison of outcomes between patients treated with DES and those who underwent CABG.
- Adjustment for baseline risk factors to compare adverse events through December 2005.
Main Results:
- CABG was associated with significantly lower 18-month rates of death and death or myocardial infarction in both three-vessel and two-vessel disease.
- For three-vessel disease, adjusted hazard ratio for death with CABG was 0.80 (95% CI, 0.65 to 0.97) and for death/MI was 0.75 (95% CI, 0.63 to 0.89).
- For two-vessel disease, adjusted hazard ratio for death with CABG was 0.71 (95% CI, 0.57 to 0.89) and for death/MI was 0.71 (95% CI, 0.59 to 0.87).
- Patients undergoing CABG also experienced lower rates of repeat revascularization.
Conclusions:
- Coronary-artery bypass grafting (CABG) demonstrates superior outcomes compared to drug-eluting stents in patients with multivessel coronary artery disease.
- CABG is associated with reduced mortality, lower rates of death or myocardial infarction, and decreased need for repeat revascularization.
Background:
Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents.
Methods:
We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients.
Results:
In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization.
Conclusions:
For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization.
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