Document Detail

Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease.
MedLine Citation:
PMID:  14993134     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The primary results of Arterial Revascularization Therapy Study reported a greater need for repeated revascularization after percutaneous coronary intervention with stenting (PCI). However, PCI was less expensive than coronary artery bypass grafting (CABG) and offered the same degree of protection against death, stroke, and myocardial infarction. METHODS AND RESULTS: Patients with multivessel disease (n=1205) were randomly assigned to either CABG or PCI and followed up for up to 3 years. Survival rates without stroke or myocardial infarction were similar in each group at 1 year and 3 years (90.5% versus 91.4% for PCI versus CABG at 1 year and 87.2% versus 88.4% for PCI versus CABG at 3 years). However, the respective repeat revascularization rates were 21.2% and 26.7% at 1 and 3 years in patients allocated to PCI, compared with 3.8% and 6.6% in patients allocated to CABG (P<0.0001). Diabetes (P<0.0009) and maximal pressure for stent deployment (P<0.002) are the strongest independent predictors of events at 3 years after PCI, whereas left anterior descending coronary artery grafting (P<0.006) is the best predictor of event-free survival at 3 years after CABG. The incremental cost of surgery compared with PCI for an event-free patient was 19 257 at 1 year but decreased to 10 492 at 3 years. It remained at 142 391 at 3 years when revascularization procedures were excluded in the efficacy end point, however. CONCLUSIONS: Three-year survival rates without stroke and myocardial infarction are identical in both groups, and the cost/benefit ratio of stenting is determined primarily by the increasing need for revascularization in the PCI group.
Victor M G Legrand; Patrick W Serruys; Felix Unger; Ben A van Hout; Mathias C M Vrolix; Geert M P Fransen; Torsten Toftegaard Nielsen; Peter Kildeberg Paulsen; Ricardo Seabra Gomes; João M G de Queiroz e Melo; José P Marques dos Santos Neves; Wietze Lindeboom; Bianca Backx;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2004-03-01
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-09     Completed Date:  2004-05-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1114-20     Citation Subset:  AIM; IM    
CHU Sart-Tilman, Liège, Belgium.
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MeSH Terms
Coronary Artery Bypass* / economics
Coronary Artery Disease / economics,  mortality,  surgery*
Cost-Benefit Analysis
Diabetes Complications
Follow-Up Studies
Middle Aged
Quality of Life
Stents* / economics
Survival Analysis
Treatment Outcome
Comment In:
Circulation. 2004 Mar 9;109(9):1079-81   [PMID:  15007018 ]

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

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