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Updated: Aug 28, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of
Jung-Min Ahn1, Do-Yoon Kang1, Sung-Cheol Yun2
1Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Long-term outcomes for multivessel coronary artery disease show no significant difference in major adverse cardiac events between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). However, PCI had higher rates of myocardial infarction and repeat revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited long-term comparative outcome data exists for percutaneous coronary intervention (PCI) with everolimus-eluting stents versus coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease.
- Multivessel coronary artery disease requires careful consideration of revascularization strategies.
Purpose of the Study:
- To compare the long-term outcomes of PCI with everolimus-eluting stents versus CABG in patients with multivessel coronary artery disease.
- To evaluate major adverse cardiac events, safety endpoints, and mortality between the two revascularization methods.
Main Methods:
- A prospective, multicenter, randomized controlled trial involving 880 patients with angiographic multivessel coronary artery disease.
- Patients were assigned to either PCI with everolimus-eluting stents or CABG.
- Median follow-up was 11.8 years.
Main Results:
- No significant difference in the primary endpoint (composite of death, myocardial infarction, or target vessel revascularization) between PCI and CABG (34.5% vs. 30.3%, P=0.26).
- No significant differences in the safety composite of death, myocardial infarction, or stroke, or in all-cause mortality.
- Higher rates of spontaneous myocardial infarction (7.1% vs. 3.8%, P=0.031) and repeat revascularization (22.6% vs. 12.7%, P<0.001) were observed after PCI compared to CABG.
Conclusions:
- In patients with multivessel coronary artery disease, PCI and CABG demonstrated similar long-term rates of major adverse cardiac events and all-cause mortality.
- PCI was associated with increased risks of spontaneous myocardial infarction and repeat revascularization compared to CABG over extended follow-up.
Background:
Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease.
Methods:
This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization.
Results:
During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG.
Conclusions:
In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifiers: NCT05125367 and NCT00997828.
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