Document Detail


Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
MedLine Citation:
PMID:  18216353     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents. METHODS: We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients. RESULTS: In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization. CONCLUSIONS: For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization.
Authors:
Edward L Hannan; Chuntao Wu; Gary Walford; Alfred T Culliford; Jeffrey P Gold; Craig R Smith; Robert S D Higgins; Russell E Carlson; Robert H Jones
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  358     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-01-29     Revised Date:  2009-03-30    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-41     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2008 Massachusetts Medical Society.
Affiliation:
Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, NY 12144-3456, USA. elh03@health.state.ny.us
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Bypass / adverse effects*
Coronary Disease / mortality,  surgery*,  therapy*
Coronary Restenosis / epidemiology
Drug-Eluting Stents / adverse effects*
Female
Humans
Male
Middle Aged
Myocardial Infarction / epidemiology,  mortality
Myocardial Revascularization / statistics & numerical data
New York / epidemiology
Observation
Postoperative Complications / epidemiology,  mortality
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Analysis
Comments/Corrections
Comment In:
N Engl J Med. 2008 Jun 12;358(24):2642; author reply 2643-4   [PMID:  18557173 ]
N Engl J Med. 2008 Jun 12;358(24):2642-3; author reply 2643-4   [PMID:  18557174 ]
Nat Clin Pract Cardiovasc Med. 2008 Aug;5(8):448-9   [PMID:  18594550 ]
N Engl J Med. 2008 Jun 12;358(24):2641-2; author reply 2643-4   [PMID:  18550881 ]
N Engl J Med. 2008 Jun 12;358(24):2643; author reply 2643-4   [PMID:  18557176 ]
N Engl J Med. 2008 Jun 12;358(24):2643; author reply 2643-4   [PMID:  18557175 ]
N Engl J Med. 2008 Jan 24;358(4):405-7   [PMID:  18216362 ]
EuroIntervention. 2008 Aug;4 Suppl C:C47-8   [PMID:  19202692 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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