Abstract 2273: Comparison of Drug-Eluting Stents and Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Disease

Abstract

Background: Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003 drug-eluting stents was introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery, and it is also unclear how the long-term outcomes of drug-eluting stents compares with that of CABG surgery. Methods: We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction) and efficacy (target-vessel revascularization) during a 2-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors among the patients. We also compared the average total costs per patient at the end of the initial hospitalization and of 1 year follow-up. Results: Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients undergoing CABG had significantly lower 2-year rates of target-vessel revascularization (1.39% versus 13.1%). The treatment with a drug-eluting stents was associated with higher rates of total mortality [adjusted hazard ratio (HR) 1.623, 95%CI 1.069 to 2.466], and myocardial infarction. (adjusted HR 1.647, 95%CI 1.147 to 2.442). For the initial hospitalization, the average total costs per patient were similar ($8035 for CABG; $8007 for drug-eluting stents). However, total follow-up costs at 1 year remained lower for CABG ($672 vs $1086) compared with treatment with drug-eluting stents. Conclusions: For patients with multivessel disease, CABG continues to be associated with lower rates of total mortality, myocardial infarction and target-vessel revascularization than does drug-eluting stents. CABG is also likely a cost-saving strategy for patients with multivessel disease.