JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Felix Unger
Magdi H. Yacoub
Peter Kildeberg Paulsen
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Unger, F.
Right arrow Articles by Kiemeneij, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Unger, F.
Right arrow Articles by Kiemeneij, F.
Related Collections
Right arrow Coronary disease

J Thorac Cardiovasc Surg 2003;125:809-820
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Revascularization in multivessel disease: Comparison between two-year outcomes of coronary bypass surgery and stenting

Felix Unger, MD, MDhca, Patrick W. Serruys, MD, PhDb, Magdi H. Yacoub, MB, FRCP, FRCS, FRS, KBEc, Charles Ilsley, MD, MB, FRCP, FRACPc, Peter Kildeberg Paulsen, MD, DMScd, Torsten Toftegaard Nielsen, MD, DMScd, Leon Eysmann, MD, PhDe, Ferdinand Kiemeneij, MD, PhDc

From the Klinik ruer Herzchirurgie, Landeskliniken Salzburg, Austria,a Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands,b Harefield Hospital, Uxbridge, Middlesex, United Kingdom,c Skejby Sygehus, Arhus N, Denmark,d and Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.e

Received for publication July 27, 2001. Revisions requested Sept 10, 2001; revisions received Nov 38, 2001. Accepted for publication Jan 10, 2002. Address for reprints: Professor F. Unger, MD, MDhc, Klinik fuer Herzchirurgie,Landeskliniken, Muellner Hauptstr. 48, A-5020, Salzburg, Austria (E-mail: f.unger{at}lks.at).

Objective: The recent appreciation that stenting has improved the short- and long-term outcomes of patients treated with coronary angioplasty has made it imperative to reconsider the comparison between surgery and percutaneous interventions in patients with multivessel disease.
Methods: One thousand two hundred five patients were randomly assigned to undergo bypass surgery or angioplasty with stent implantation when there was consensus between the cardiac surgeon and interventional cardiologist as to equivalent treatability. The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at 1 year. Major adverse cardiac and cerebrovascular events at 2 years constituted a secondary end point.
Results: At 2 years, 89.6% of the surgical group and 89.2% of the stent group were free from death, stroke, and myocardial infarction (log-rank test P = .65). Among patients who survived without stroke or myocardial infarction, 19.7% in the stent group underwent a second revascularization, as compared with 4.8% in the surgical group (P < .001). At 2 years, 84.8% of the surgical group and 69.5% of the stent group were event-free survivors (log-rank test P < .001), and 87.2% in the surgical cohort and 79.6 % in the stent group were angina-free survivors (P = .001). In the diabetes subgroup, 82.3% of the surgical group and 56.3% of the stent group were free from any events after 2 years (log-rank test P < .001).
Conclusion: The difference in outcome between surgery and stenting observed at 1 year in patients with multivessel disease remained essentially unchanged at 2 years. Stenting was associated with a greater need for repeat revascularization. In view of the relatively greater difference in outcome in patients with diabetes, surgery clearly seems to be the preferable form of treatment for these patients.




This article has been cited by other articles:


Home page
 ICVTSHome page
F. Unger
Drug eluting stents a nightmare?
Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 813 - 814.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky
Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery
Ann Intern Med, November 20, 2007; 147(10): 703 - 716.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
D. R. Holmes Jr, J. W. Moses, J. Schofer, M.-C. Morice, E. Schampaert, and M. B. Leon
Cause of death with bare metal and sirolimus-eluting stents
Eur. Heart J., December 1, 2006; 27(23): 2815 - 2822.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. F. Gummert, S. Demertzis, K. Matschke, U. Kappert, M. Anssar, F. Siclari, V. Falk, E. L. Alderman, and W. Harringer
Six-Month Angiographic Follow-Up of the PAS-Port II Clinical Trial
Ann. Thorac. Surg., January 1, 2006; 81(1): 90 - 96.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. E. Matschke, J. F. Gummert, S. Demertzis, U. Kappert, M. B. Anssar, F. Siclari, V. Falk, E. L. Alderman, C. Detter, H. Reichenspurner, et al.
The Cardica C-Port System: Clinical and angiographic evaluation of a new device for automated, compliant distal anastomoses in coronary artery bypass grafting surgery--A multicenter prospective clinical trial
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1645 - 1652.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The American Association for Thoracic Surgery.