TY - JOUR
T1 - Coronary artery bypass graft surgery versus drug-eluting stents for patients with isolated proximal left anterior descending disease
AU - Hannan, Edward L.
AU - Zhong, Ye
AU - Walford, Gary
AU - Holmes, David R.
AU - Venditti, Ferdinand J.
AU - Berger, Peter B.
AU - Jacobs, Alice K.
AU - Stamato, Nicholas J.
AU - Curtis, Jeptha P.
AU - Sharma, Samin
AU - King, Spencer B.
N1 - Funding Information:
Dr. Curtis has equity interest in Medtronic. Dr. Sharma has received research grant support from Boston Scientific Inc .; and serves on the speakers bureau of Boston Scientific Inc., Abbott Vascular, Eli Lilly, The Medicine Co., Angioscore, Boston Scientific Corporation, Cardiovascular Systems Inc., and DSI/Lilly. Dr. King has received payment for serving on the advisory boards of Medtronic, Merck & Co., Inc., Wyeth, Capricor, Harvard Clinical Research Institute, and Duke University; and receives minimal consulting fees as a scientific advisor for Celanova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2014 American College of Cardiology Foundation.
PY - 2014/12/30
Y1 - 2014/12/30
N2 - BACKGROUND: Few recent studies have compared the outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary interventions (PCIs) in patients with isolated (single vessel) proximal left anterior descending (PLAD) coronary artery disease in the era of drug-eluting stents (DES).OBJECTIVES: The goal of this study was to compare outcomes in patients with PLAD who underwent CABG and PCI with DES.METHODS: New York's Percutaneous Coronary Interventions Reporting System was used to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008 and December 31, 2010, and who were followed-up through December 31, 2011. A total of 5,340 of 6,064 (88%) patients received DES. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York's administrative data to obtain readmissions for myocardial infarction (MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and/or DES pairs, and 3 outcome measures were compared across the pairs.RESULTS: Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and/or stroke, but repeat revascularization rates were lower for CABG (7.09% vs. 12.98%; p = 0.0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates (CABG and/or DES adjusted hazard ratio (AHR): 1.14; 95% confidence interval [CI]: 0.70 to 1.85) or mortality, MI, and/or stroke rates (AHR: 1.15; 95% CI: 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients (AHR: 0.54; 95% CI: 0.36 to 0.81).CONCLUSIONS: Despite the higher rating in current guidelines of CABG (Class IIa vs. Class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates.
AB - BACKGROUND: Few recent studies have compared the outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary interventions (PCIs) in patients with isolated (single vessel) proximal left anterior descending (PLAD) coronary artery disease in the era of drug-eluting stents (DES).OBJECTIVES: The goal of this study was to compare outcomes in patients with PLAD who underwent CABG and PCI with DES.METHODS: New York's Percutaneous Coronary Interventions Reporting System was used to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008 and December 31, 2010, and who were followed-up through December 31, 2011. A total of 5,340 of 6,064 (88%) patients received DES. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York's administrative data to obtain readmissions for myocardial infarction (MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and/or DES pairs, and 3 outcome measures were compared across the pairs.RESULTS: Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and/or stroke, but repeat revascularization rates were lower for CABG (7.09% vs. 12.98%; p = 0.0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates (CABG and/or DES adjusted hazard ratio (AHR): 1.14; 95% confidence interval [CI]: 0.70 to 1.85) or mortality, MI, and/or stroke rates (AHR: 1.15; 95% CI: 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients (AHR: 0.54; 95% CI: 0.36 to 0.81).CONCLUSIONS: Despite the higher rating in current guidelines of CABG (Class IIa vs. Class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates.
KW - CABG surgery
KW - PCI
KW - outcomes
KW - proximal left anterior descending disease
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U2 - 10.1016/j.jacc.2014.09.074
DO - 10.1016/j.jacc.2014.09.074
M3 - Article
C2 - 25541122
AN - SCOPUS:84919628894
SN - 0735-1097
VL - 64
SP - 2717
EP - 2726
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -