Randomized, controlled trial of coronary artery bypass surgery versus percutaneous coronary intervention in patients...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• The Stent or Surgery Trial previously indicated a survival benefit for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) at 2 years.
• This study extends the follow-up to assess long-term survival outcomes.

Purpose of the Study:

• To compare the 6-year survival rates between patients with multivessel coronary artery disease treated with PCI versus CABG.

Main Methods:

• A randomized controlled trial involving 988 patients (488 PCI, 500 CABG) across 53 centers.
• Survival status was determined through medical records and national databases.
• All-cause mortality was analyzed using Cox proportional hazards models, with subgroup analyses for diabetes, angina severity, and coronary disease severity.

Main Results:

• At 6-year follow-up, all-cause mortality was 10.9% in the PCI group versus 6.8% in the CABG group (Hazard Ratio 1.66, P=0.022).
• No significant interaction was found, indicating the survival advantage of CABG was consistent across subgroups based on angina grade, coronary disease severity, and diabetic status.

Conclusions:

• Coronary artery bypass grafting (CABG) demonstrated a sustained survival advantage over percutaneous coronary intervention (PCI) at 6 years for patients with multivessel disease.
• This outcome contrasts with findings from some other stent-versus-CABG studies, highlighting the importance of long-term follow-up.