Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease
BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point - a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. Results Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P = 0.003). CONCLUSIONS CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (CIinicaITriaIs.gov number, NCT00114972.).
|Keywords||Kaplan Meier method, acetylsalicylic acid, adult, aged, amiodarone, angiotensin receptor antagonist, anticoagulant agent, antithrombocytic agent, article, beta adrenergic receptor blocking agent, calcium channel blocking agent, cardiovascular disease, cerebrovascular accident, classification, clinical trial, comparative study, controlled clinical trial, controlled study, coronary artery bypass graft, coronary artery disease, dipeptidyl carboxypeptidase inhibitor, disease severity, drug eluting stent, female, heart infarction, heart muscle revascularization, histamine H2 receptor antagonist, hospitalization, human, hydroxymethylglutaryl coenzyme A reductase inhibitor, in-stent restenosis, intermethod comparison, major clinical study, male, middle aged, mortality, multicenter study, paclitaxel, percutaneous coronary intervention, preoperative period, priority journal, prospective study, randomized controlled trial, retreatment, stroke, thienopyridine derivative, transluminal coronary angioplasty, treatment outcome, unclassified drug, warfarin derivative|
|Persistent URL||dx.doi.org/10.1056/NEJMoa0804626, hdl.handle.net/1765/18230|
|Note||Free full at PubMed|
Serruys, P.W.J.C., Morice, M-C., Kappetein, A.P., Colombo, A., Holmes, D.R., Jr, Mack, M.J., … Mohr, F.W.. (2009). Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. New England Journal of Medicine, 360(10), 961–972. doi:10.1056/NEJMoa0804626