The BEST trial is here - but is anyone listening?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Multivessel coronary artery disease (CAD) requires effective revascularization strategies.
• Coronary Artery Bypass Surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents are primary treatment options.
• Long-term comparative data is crucial for treatment selection in complex CAD.

Purpose of the Study:

• To evaluate the long-term outcomes of CABG compared to PCI with everolimus-eluting stents (EES) in patients with multivessel CAD.
• To critically appraise the main findings of the recent publication from the Randomized Comparison of CABG and EES Implantation trial.

Main Methods:

• Analysis of long-term follow-up data from a randomized controlled trial.
• Comparison of clinical endpoints between CABG and EES groups.
• Assessment of major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

• The long-term outcomes of CABG and EES implantation for multivessel CAD are comparable.
• No significant difference in MACCE was observed between the two treatment groups over the long term.
• Specific subgroup analyses may reveal nuances in treatment effectiveness.

Conclusions:

• Both CABG and EES implantation provide durable and effective revascularization for patients with multivessel CAD.
• The choice of treatment should be individualized based on patient-specific factors and physician expertise.
• Continued long-term surveillance is important for understanding the full impact of these interventions.