Abstract
Multivessel coronary artery disease is more often treated either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) with stenting. The advent of drug-eluting stent (DES) has changed the revascularization strategy, and caused an increase in the use of DES in multivessel disease (MVD), with reduced rate of repeat revascularization compared to conventional bare metal stent. The comparative studies of DES-PCI over CABG have shown comparable safety; however, the rate of major adverse cerebrovascular and cardiac events and repeat revascularization was significantly higher with DES-PCI at long term. In diabetic patients with MVD, concern of repeat revascularization with DES-PCI is persistent. More recent, one-year economic outcomes have reported that the CABG is favored among patients with high angiographic complexity. The higher rate of repeat revascularization with DES-PCI in MVD would lead to increased economic burden on patient at long term besides bearing high cost of DES. In diabetic MVD patients, CABG is associated with having better clinical outcomes and being more cost-effective approach when compared to DES-PCI at long term.
Highlights
Coronary Artery Disease (CAD) is a major public health and medical concern in both developed and developing countries [1]
In light of the above facts, this paper summarizes the outcomes of contributing important clinical and pharmaco-economic coronary intervention studies comparing use of drug-eluting stents (DES)-Percutaneous Coronary Intervention (PCI) with Coronary Artery Bypass Grafting (CABG) in multivessel disease (MVD) patients
(b) In 5-year followup of ARTS trial, results reported that CABG has comparable safety and superior efficacy compared to Bare Metal Stent (BMS) and Sirolimus Eluting Stent (SES) in diabetic patients with MVD, with significantly lower rate of repeat revascularization (SES 33.2% versus CABG 10.7%, P < 0.001) [43]
Summary
Coronary Artery Disease (CAD) is a major public health and medical concern in both developed and developing countries [1]. As compared to balloon angioplasty, BMS-PCI reduced the rate of repeat revascularization in MVD from 54% to 28% as reported in several studies like BARI, ERACI II, and ARTS trials [10,11,12]. These studies established the safety and effectiveness of BMS-PCI in MVD and encouraged its use in interventional practice. In MVD patients BMS-PCI reduces rate of repeat revascularization as compared to balloon angioplasty but has higher repeat revascularization as compared to CABG accounting for increased follow-up cost with similar longterm safety profile
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