Long-Term Comparison of Drug-Eluting Stents and Coronary Artery Bypass Grafting for Multivessel Coronary Revascularization: 5-Year Outcomes From the Asan Medical Center-Multivessel Revascularization Registry

• Published in: Journal of the American College of Cardiology 2011-01, Vol.57 (2), p.128-137
• Main Authors: PARK, Duk-Woo, KIM, Young-Hak, PARK, Seong-Wook, YUN, Sung-Cheol, SUNG HO JUNG, CHOO, Suk-Jung, CHUNG, Cheol-Hyun, LEE, Jae-Won, PARK, Seung-Jung, SONG, Hae-Geun, AHN, Jung-Min, OH, Junhyok, KIM, Won-Jang, LEE, Jong-Young, KANG, Soo-Jin, LEE, Seung-Whan, LEE, Cheol-Whan
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Clinical outcomes; Coronary Artery Bypass - methods; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Coronary heart disease; Coronary vessels; Drug therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Heart; Heart attacks; Humans; Korea - epidemiology; Male; Medical sciences; Middle Aged; Mortality; Myocardial Revascularization - methods; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate - trends; Time Factors; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.09.022

We performed the long-term (5-year) follow-up of a large cohort of patients who underwent drug-eluting stent (DES) or coronary artery bypass graft (CABG) surgery for multivessel revascularization. Limited information is available on very long-term outcomes after multivessel DES treatment relative to CABG. We evaluated 3,042 patients with multivessel disease who received DES (n = 1,547) or underwent CABG (n = 1,495) between January 2003 and December 2005, and for whom complete follow-up data were available for a median 5.6 years (interquartile range: 4.6 to 6.3 years). We compared adverse outcomes (death; a composite outcome of death, myocardial infarction, or stroke; and repeat revascularization). After adjustment for differences in baseline risk factors, 5-year risk of death (hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.76 to 1.32, p = 0.99) and the combined risk of death, myocardial infarction, or stroke (HR: 0.97; 95% CI: 0.76 to 1.24, p = 0.81) were similar between the DES group and the CABG group. However, the rates of revascularization were significantly higher in the DES group (HR: 2.93; 95% CI: 2.20 to 3.90, p < 0.001). Similar results were obtained in comparisons of DES with CABG for high-risk clinical and anatomic subgroups with diabetes mellitus, abnormal ventricular function, age 65 years or more, and 3-vessel and left main disease. However, mortality benefit with DES implantation relative to CABG was noted in patients with 2-vessel disease (HR: 0.57; 95% CI: 0.36 to 0.92, p = 0.02). For patients with multivessel disease, DES treatment, compared with CABG, showed similar rates of mortality and of the composite safety outcomes, but higher rates of revascularization up to 5 years.