June 1, 2005
Bedrood B.S. and Asher Kimchi M.D.
NY - Coronary-Artery Bypass Grafting (CABG) and
percutaneous coronary intervention (PCI) have been the
predominant therapeutic procedures for coronary artery
occlusion. Though stenting procedures have made great
advancements over the last few years, there have been no recent
studies comparing the outcomes of stenting and CABG for patients
with advanced coronary artery disease. Edward Hannan M.D. et al
from the University at
University of New York used observational
data from a large registry to compare short-term and long-term
outcomes among patients with multi-vessel disease who underwent
CABG or stenting. The study was published in the
May 26, 2005
issue of The New England Journal of Medicine and found
that for patients with two or more diseased coronary arteries,
CABG is associated with higher adjusted rates of long-term
survival than stenting.
The study identified 37,212 patients with multi-vessel
disease who underwent CABG and 22,102 patients with multi-vessel
disease who underwent PCI from
December 31, 2000.
The rate of death and subsequent revascularization within three
years after the procedure was determined. End points included
death and death or revascularization (CABG or PCI) at any time
before December 31, 2000.
Survival rates were significantly higher for the patients who
underwent CABG than those who received a stent. The adjusted
hazard ratio for the long-term risk of death after CABG relative
to stent implantation was 0.64 (95 percent confidence interval,
0.56 to 0.74) for patients with three-vessel disease with
involvement of the proximal left anterior descending coronary
artery and 0.76 (95 percent confidence interval, 0.60 to 0.96)
for patients with two-vessel disease with involvement of the
nonproximal left anterior descending coronary artery. Also, the
three-year rates of revascularization were considerably higher
in the stenting group than in the CABG group (7.8 percent vs.
0.3 percent for subsequent CABG and 27.3 percent vs. 4.6 percent
for subsequent PCI).
There are many considerations a physician and patient need to
account for before determining the appropriate treatment. While
stenting is less invasive and associated with lower in-hospital
mortality at the time of the procedure, CABG has a higher rate
of long-term survival.