Circulation: CABG is more effective than DES in reducing repeat revascularization

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For the treatment of multi-vessel coronary artery disease, PCI with drug-eluting stents (DES) implantation showed a significantly lower rate of revascularization than with coronary artery bypass grafting (CABG), according to an observational study published in the April 22 issue of Circulation.

 “Limited data exist regarding the long-term outcomes among patients with multi-vessel disease who underwent CABG or PCI with DES,” according to the researchers.

As a result, Duk-Woo Park, MD, from the division of cardiology at the Asan Medical Center, Seoul, Korea, and colleagues compared the long-term outcomes of coronary implantation with DES and CABG in patients with multivessel disease.

Between January 2003 and December 2005, the researchers examined 3,042 patients with multi-vessel disease underwent coronary implantation of DES (1,547 patients) or CABG (1,495 patients).

The choice of the specific type of DES (i.e., sirolimus-eluting Cypher stent from Cordis, Johnson & Johnson of Miami Lakes, Fla., or paclitaxel-eluting Taxus stent from Boston Scientific of Natick, Mass.) was left to the operator’s discretion.

The authors wrote that the primary end point was all-cause mortality; and the secondary end points were repeat revascularization and the composite of death, Q-wave MI and cerebrovascular events.

In a crude analysis, researchers found that the rate of long-term mortality was significantly higher in patients who underwent CABG than in those who underwent DES implantation (three-year unadjusted mortality rate, 7.0 percent for CABG vs. 4.4 percent for PCI).

However, after adjustment for baseline differences, the investigators noted that the overall risk of death was similar among all patients, diabetic patients and patients with compromised ventricular function.

In the anatomic subgroups, mortality benefit with DES implantation was noted in patients with two-vessel disease with involvement of the nonproximal left anterior descending artery, the authors wrote.

The investigators also noted that repeat revascularization after index treatment was more common in patients treated with DES.

Overall, Park and colleagues found that rate of revascularization was significantly higher in the DES than in the CABG group.

In the discussion, the researchers noted that the “study showed that even with the more pronounced differences in repeat revascularization observed in diabetic patients, the overall long-term mortality was similar for the two treatments regardless of diabetic status,” which is consistent with previous studies.

Park and colleagues recommended that a comparison of PCI with DES or CABG in patients with multi-vessel coronary disease awaits the results of ongoing randomized trials.