Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

Patrick W. Serruvs, Marie Claude Morice, A. Pieter Kappetein, Antonio Colombo, David Holmes, Michael J. Mack, Elisabeth Ståhle, Ted E. Feldman, Marcel Van Den Brand, Eric J. Bass, Nic Van Dyck, Katrin Leadley, Keith D. Dawkins, Friedrich W. Mohr

Research output: Contribution to journalArticle

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Abstract

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.).

Original languageEnglish (US)
Pages (from-to)961-972
Number of pages12
JournalNew England Journal of Medicine
Volume360
Issue number10
DOIs
StatePublished - Mar 5 2009

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Artery Disease
Stroke
Myocardial Infarction
Drug-Eluting Stents
Standard of Care
Random Allocation
Registries
Cause of Death
Therapeutics
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. / Serruvs, Patrick W.; Morice, Marie Claude; Kappetein, A. Pieter; Colombo, Antonio; Holmes, David; Mack, Michael J.; Ståhle, Elisabeth; Feldman, Ted E.; Van Den Brand, Marcel; Bass, Eric J.; Van Dyck, Nic; Leadley, Katrin; Dawkins, Keith D.; Mohr, Friedrich W.

In: New England Journal of Medicine, Vol. 360, No. 10, 05.03.2009, p. 961-972.

Research output: Contribution to journalArticle

Serruvs, PW, Morice, MC, Kappetein, AP, Colombo, A, Holmes, D, Mack, MJ, Ståhle, E, Feldman, TE, Van Den Brand, M, Bass, EJ, Van Dyck, N, Leadley, K, Dawkins, KD & Mohr, FW 2009, 'Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease', New England Journal of Medicine, vol. 360, no. 10, pp. 961-972. https://doi.org/10.1056/NEJMoa0804626
Serruvs, Patrick W. ; Morice, Marie Claude ; Kappetein, A. Pieter ; Colombo, Antonio ; Holmes, David ; Mack, Michael J. ; Ståhle, Elisabeth ; Feldman, Ted E. ; Van Den Brand, Marcel ; Bass, Eric J. ; Van Dyck, Nic ; Leadley, Katrin ; Dawkins, Keith D. ; Mohr, Friedrich W. / Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. In: New England Journal of Medicine. 2009 ; Vol. 360, No. 10. pp. 961-972.
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AU - Serruvs, Patrick W.

AU - Morice, Marie Claude

AU - Kappetein, A. Pieter

AU - Colombo, Antonio

AU - Holmes, David

AU - Mack, Michael J.

AU - Ståhle, Elisabeth

AU - Feldman, Ted E.

AU - Van Den Brand, Marcel

AU - Bass, Eric J.

AU - Van Dyck, Nic

AU - Leadley, Katrin

AU - Dawkins, Keith D.

AU - Mohr, Friedrich W.

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N2 - 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.).

AB - 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.).

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