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J Thorac Cardiovasc Surg 2008;136:500-506
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Long-term clinical outcome of coronary artery stenting or coronary artery bypass grafting in patients with multiple-vessel disease

Shun Kohsaka, MDa,d,*, Masashi Goto, MD, MPHe, Salim Virani, MDa,d, Vei-Vei Lee, MSb, Noriaki Aoki, MD, PhDe, MacArthur A. Elayda, MD, PhDa,b, Ross M. Reul, MDc, James M. Wilson, MDa,d

a Division of Cardiology, the Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
b Division of Biostatistics, the Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
c Division of Cardiovascular Surgery, the Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
d Divisions of Cardiology and Cardiovascular Surgery, Baylor College of Medicine, Houston, Tex
e School of Health Information Sciences, the University of Texas at Houston, Houston, Tex

Received for publication July 11, 2007; revisions received October 26, 2007; accepted for publication November 1, 2007.

* Address for reprints: Shun Kohsaka, MD, Division of Cardiology, 622 W 168th St PH 3-137, New York, NY 10032. (Email: sk2798{at}columbia.edu).

Objective: Recent large-scale observational studies have shown better outcomes after coronary artery bypass grafting than after angioplasty or stenting in patients with multiple-vessel disease. The time frames of these studies, however, include periods of varying behavior with respect to patient selection, stent technique and design, and medical therapy. Our objective was to examine long-term outcomes of coronary stenting and coronary artery bypass grafting, including those performed in the contemporary era of aggressive medical therapy.

Methods: We examined in-hospital and long-term follow-up data from consecutive patients with multivessel coronary artery disease who underwent isolated initial revascularization by coronary stenting or coronary artery bypass grafting between 1995 and 2003. Cox proportional hazards modeling with propensity scoring and propensity-based case matching were used to compare long-term survival and correct for baseline differences between the populations.

Results: A total of 6847 patients were studied (stenting 3917, coronary artery bypass grafting 2930). Each patient had 1 to 9 years of follow-up (median 3.5 years). Unadjusted long-term mortalities were similar for coronary artery bypass grafting and stenting (hazard ratio 1.1, 95% confidence interval 0.9–1.2, P = .21). Matched comparison of 3488 patients (1856 in each group) with similar likelihoods of undergoing coronary stenting or coronary artery bypass grafting, however, suggested that coronary artery bypass grafting provided better long-term survival (hazard ratio 0.7, 95% confidence interval 0.6–0.9; P = .004).

Conclusion: During a 9-year period, in physician-selected patients with favorable demographic characteristics for both revascularization procedures, coronary artery bypass grafting was associated with better long-term survival than stent-assisted angioplasty.

Abbreviations and Acronyms BARI = Bypass Angioplasty Revascularization Investigation; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CI = confidence interval; HR = hazard ratio; MI = myocardial infarction; OR = odds ratio; PCI = percutaneous coronary intervention; THIRDBase = Texas Heart Institute Research Database






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