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J Thorac Cardiovasc Surg 2005;130:512-519
© 2005 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Department of Interventional Cardiology and Clinical Epidemiology Unit, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
b Cardiovascular Center, OLV Hospital, Aalst, Belgium
c Division of Cardiology, University Hospital, Geneva, Switzerland
d Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, United Kingdom
e Cardiothoracic Centre, Liverpool, United Kingdom
f Department of Medicine and Division of Cardiology William Beaumont Hospital, Royal Oak, Mich
g Otamendi Hospital, Buenos Aires, Argentina
h Heart Institute of the University of São Paulo, São Paulo, Brazil
i Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minn
Received for publication March 26, 2004; revisions received December 21, 2004; accepted for publication December 23, 2004. * Address for reprints: Eric Boersma, PhD, Clinical Epidemiology Unit, Room H-543, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands (Email: h.boersma{at}erasmusmc.nl).
BACKGROUND: We aimed to provide a quantitative analysis of the 1-year clinical outcomes of patients with multisystem coronary artery disease who were included in recent randomized trials of percutaneous coronary intervention with multiple stenting versus coronary artery bypass graft surgery.
METHODS: An individual patient database was composed of 4 trials (Arterial Revascularization Therapies Study, Stent or Surgery Trial, Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 2, and Medicine, Angioplasty, or Surgery Study 2) that compared percutaneous coronary intervention with multiple stenting (N = 1518) versus coronary artery bypass graft surgery (N = 1533). The primary clinical end point of this study was the combined incidence of death, myocardial infarction, and stroke at 1 year after randomization. Secondary combined end points included the incidence of repeat revascularization at 1 year. All analyses were based on the intention-to-treat principle.
RESULTS: After 1 year of follow-up, 8.7% of patients randomized to percutaneous coronary intervention with multiple stenting versus 9.1% of patients randomized to coronary artery bypass graft surgery reached the primary clinical end point (hazard ratio 0.95 and 95% confidence interval 0.74’1.2). Repeat revascularization procedures occurred more frequently in patients allocated to percutaneous coronary intervention with multiple stenting compared with coronary artery bypass graft surgery (18% vs 4.4%; hazard ratio 4.4 and 95% confidence interval 3.3’5.9). The percentage of patients who were free from angina was slightly lower after percutaneous coronary intervention with multiple stenting than after coronary artery bypass graft surgery (77% vs 82%; P = .002).
CONCLUSIONS: One year after the initial procedure, percutaneous coronary intervention with multiple stenting and coronary artery bypass graft surgery provided a similar degree of protection against death, myocardial infarction, or stroke for patients with multisystem disease. Repeat revascularization procedures remain high after percutaneous coronary intervention, but the difference with coronary artery bypass graft surgery has narrowed in the era of stenting.
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