State of the art in coronary revascularization: Everolimus eluting stents versus multiple arterial grafting
Related Experiment Video
Updated: Mar 18, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Umberto Benedetto1, Massimo Caputo1, Hunaid Vohra1
1Bristol Heart Institute, University of Bristol, School of Clinical Sciences, United Kingdom.
Insights
Coronary artery bypass grafting with multiple arterial grafts (MAGs) offers improved long-term survival compared to percutaneous coronary intervention with everolimus-eluting stents (EESs) in multivessel coronary artery disease patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Contemporary coronary revascularization strategies involve percutaneous coronary intervention (PCI) with new-generation everolimus-eluting stents (EESs) and coronary artery bypass grafting (CABG) with multiple arterial grafts (MAGs).
- Patients with multivessel coronary artery disease require effective revascularization strategies to improve outcomes and survival.
Purpose of the Study:
- To compare early outcomes and late survival between EES and MAG in patients with multivessel coronary artery disease.
- To evaluate the efficacy of different revascularization approaches in a real-world setting.
Main Methods:
- An observational registry study included 3787 patients with multivessel coronary disease.
- Propensity-score matching created 483 comparable pairs for EES (n=696) versus MAG (n=3091).
- Mean follow-up was 3.1 years.
Main Results:
- Thirty-day mortality and stroke rates were similar between the EES and MAG groups.
- PCI with EES was associated with a significantly higher risk of late death (HR 2.2; P=0.01).
- MAG demonstrated superior long-term survival.
Conclusions:
- CABG with MAG is associated with significantly improved long-term survival compared to PCI with EES in multivessel coronary artery disease.
- Further randomized trials are needed to confirm optimal revascularization strategies.
Background:
Contemporary comparisons on coronary revascularization should take into account the state of the art percutaneous coronary intervention (PCI) with new generation everolimus-eluting stents (EESs) and coronary artery bypass grafting (CABG) with multiple arterial grafts (MAGs). We aimed to compare early outcomes and late survival after EES versus MAG in patients with multivessel coronary artery disease using a single centre institutional database.
Methods:
In an observational registry study, we identified 3787 patients with multivessel coronary disease. Of these 696 (18.3%) underwent PCI with EES and 3091 (81.7%) CABG with MAG. With the use of propensity-score matching, we identified 483 pairs for final comparison (C-statistic: 0.91).
Results:
The two groups were comparable for 30-day mortality (1.6% versus 0.8% in the EES and MAG group respectively, P=0.38). Stroke was not observed in the EES group and it was 0.8% in the MAG group (P=0.13). After a mean follow-up of 3.1years, PCI with EES was associated with a higher risk of late death (HR 2.2; 95% CI 1.18-4.16; P=0.01).
Conclusions:
In patients with multivessel coronary disease, CABG with multiple arterial grafts when compared with PCI with new generation drug eluting stent, was associated with significantly improved long-term survival. Further randomized studies are warranted to identify the best revascularization strategies in the current era.
