Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-05, Vol.133 (22), p.2132-2140
• Main Authors: Bangalore, Sripal, Guo, Yu, Samadashvili, Zaza, Blecker, Saul, Hannan, Edward L
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease; Drug-Eluting Stents - adverse effects; Everolimus - administration & dosage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Revascularization - adverse effects; Myocardial Revascularization - mortality; Severity of Illness Index; Survival Rate; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - therapy
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.115.021168

BACKGROUND—Guidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials. METHODS AND RESULTS—Patients with multivessel disease and severe left ventricular systolic dysfunction (ejection fraction ≤35%) who underwent either PCI with everolimus-eluting stent or CABG were selected from the New York State registries. The primary outcome was long-term all-cause death. Secondary outcomes were individual outcomes of myocardial infarction, stroke, and repeat revascularization. Among the 4616 patients who fulfilled our inclusion criteria (1351 everolimus-eluting stent and 3265 CABG), propensity score matching identified 2126 patients with similar propensity scores. In the short term, PCI was associated with a lower risk of stroke (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.01–0.39; P=0.004) in comparison with CABG. At long-term follow-up (median, 2.9 years), PCI was associated with a similar risk of death (HR, 1.01; 95% CI, 0.81–1.28; P=0.91), a higher risk of myocardial infarction (HR, 2.16; 95% CI, 1.42–3.28; P=0.0003), a lower risk of stroke (HR, 0.57; 95% CI, 0.33–0.97; P=0.04), and a higher risk of repeat revascularization (HR, 2.54; 95% CI, 1.88–3.44; P