Drug-Eluting Stents vs Coronary-Artery Bypass Grafting in Multivessel Coronary Disease

Abstract

Conclusion: Treatment of patients with multi vessel coronary disease with coronary artery bypass (CABG) results in lower mortality rates than does treatment with drug-eluting stents. CABG is also associated with lower rates of myocardial infarction, death and repeat revascularization. Summary: The authors sought to compare the efficacy of CABG and coronary stenting in the era of drug-eluting stents. Patients with multi vessel coronary disease in New York state between October 1, 2003 and December 31, 2004, and who were treated with drug-eluting stents or CABG were identified. Adverse outcomes defined as death, death or myocardial infarction, or repeat revascularization occurring through December 31, 2005, were compared in the two groups. Adjustments were made for differences in risk. CABG, in comparison to drug-eluting stents, was associated with lower 18 month rates of death, and rates of death or myocardial infarction in both patients with two and three vessel coronary disease. In patients with three vessel disease who underwent CABG the adjusted hazard ratio for death compared to those who received stents was 0.8 (95% CI 0.65-0.97). Adjusted survival rate was 94% versus 92.7% (P = 0.03). The adjusted hazard ratio for myocardial infarction or death was 0.75 (95% CI 0.63-0.89). The adjusted survival free from myocardial infarction was 92.1% in those treated with CABG versus 89.7% in those treated with stents (P < 0.001). In the patients with two vessel coronary disease who underwent CABG opposed to those who received a stent adjusted hazard ratio for death was 0.71 (95% CI 0.57-0.89). Adjusted survival rate was 96% versus 94.6% (P = 0.003). The adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI 0.59-0.87). Adjusted survival rate free from myocardial infarction was 94.5% versus 92.5% (P < 0.001). Rates of revascularization were also lower in those patients undergoing CABG versus those having stent placement. Comment: This observational study compared off label use of drug-eluting stents to CABG. The data affirm the fact that CABG is the standard for care for those who require multi vessel coronary revascularization. For properly informed patients who wish a less invasive alternative stents may also be considered.