Long-term mortality after percutaneous coronary intervention with drug-eluting stent implantation versus coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Long-term outcomes of percutaneous coronary intervention with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for multivessel coronary artery disease beyond one year remain unevaluated.
• Previous studies have primarily focused on shorter-term comparisons between these revascularization strategies.

Purpose of the Study:

• To compare the long-term mortality and revascularization rates between DES implantation and CABG in patients with multivessel coronary artery disease.
• To evaluate treatment effects beyond the first year post-intervention.

Main Methods:

• A cohort study involving 3042 patients with multivessel disease from January 2003 to December 2005.
• Patients underwent either DES implantation (n=1547) or CABG (n=1495).
• Primary endpoint was all-cause mortality, with subsequent adjusted analyses for baseline differences and subgroup evaluations.

Main Results:

• Crude analysis showed higher mortality with CABG (7.0%) versus DES (4.4%) at 3 years (P=0.01).
• After adjustment, overall mortality risk was similar between DES and CABG (HR, 0.85; P=0.45), including in diabetic patients and those with compromised ventricular function.
• DES implantation demonstrated a mortality benefit in patients with 2-vessel disease involving the non-proximal left anterior descending artery (HR, 0.23; P=0.016).
• Revascularization rates were significantly higher in the DES group (HR, 2.81; P<0.001).

Conclusions:

• Percutaneous coronary intervention with DES implantation provides equivalent long-term mortality outcomes compared to CABG for treating multivessel coronary artery disease.
• DES may offer specific advantages in certain patient anatomies, although it is associated with a higher need for repeat revascularization.