| 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 |
Related Documents
:
|
12632813 - Determinants of successful surgical revascularization for failed angioplasty in patient... 11178303 - The octopus ii stabilizing system: biochemical and neuropsychological outcomes in coron... 16839463 - High mechanical efficiency of left ventricular arrhythmic contractions during atrial fi... |
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 |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| 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
Previous Document: Development of a clinical research agenda for acute kidney injury using an international, interdisci...
Next Document: A comparison of bare-metal and drug-eluting stents for off-label indications.