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Article: Everolimus-eluting stents or bypass surgery for multivessel coronary disease

TitleEverolimus-eluting stents or bypass surgery for multivessel coronary disease
Authors
Issue Date2015
Citation
New England Journal of Medicine, 2015, v. 372, n. 13, p. 1213-1222 How to Cite?
AbstractCopyright © 2015 Massachusetts Medical Society. BACKGROUND: Results of trials and registry studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. These previous analyses did not evaluate PCI with second-generation drug-eluting stents. METHODS: In an observational registry study, we compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS: Among 34,819 eligible patients, 9223 patients who underwent PCI with everolimus-eluting stents and 9223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93 to 1.17; P = 0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29 to 1.77; P<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14 to 2.58; P<0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization but was significant among those with incomplete revascularization (P = 0.02 for interaction). CONCLUSIONS: In a contemporary clinical-practice registry study, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but a lower risk of stroke. (Funded by Abbott Vascular.)
Persistent Identifierhttp://hdl.handle.net/10722/219780
ISSN
2015 Impact Factor: 59.558
2015 SCImago Journal Rankings: 14.619
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorBangalore, Sripal-
dc.contributor.authorGuo, Yu-
dc.contributor.authorSamadashvili, Zaza-
dc.contributor.authorBlecker, Saul-
dc.contributor.authorXu, Jinfeng-
dc.contributor.authorHannan, Edward L.-
dc.date.accessioned2015-09-23T02:57:56Z-
dc.date.available2015-09-23T02:57:56Z-
dc.date.issued2015-
dc.identifier.citationNew England Journal of Medicine, 2015, v. 372, n. 13, p. 1213-1222-
dc.identifier.issn0028-4793-
dc.identifier.urihttp://hdl.handle.net/10722/219780-
dc.description.abstractCopyright © 2015 Massachusetts Medical Society. BACKGROUND: Results of trials and registry studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. These previous analyses did not evaluate PCI with second-generation drug-eluting stents. METHODS: In an observational registry study, we compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS: Among 34,819 eligible patients, 9223 patients who underwent PCI with everolimus-eluting stents and 9223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93 to 1.17; P = 0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29 to 1.77; P<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14 to 2.58; P<0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization but was significant among those with incomplete revascularization (P = 0.02 for interaction). CONCLUSIONS: In a contemporary clinical-practice registry study, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but a lower risk of stroke. (Funded by Abbott Vascular.)-
dc.languageeng-
dc.relation.ispartofNew England Journal of Medicine-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleEverolimus-eluting stents or bypass surgery for multivessel coronary disease-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1056/NEJMoa1412168-
dc.identifier.pmid25775087-
dc.identifier.scopuseid_2-s2.0-84925423333-
dc.identifier.hkuros260475-
dc.identifier.volume372-
dc.identifier.issue13-
dc.identifier.spage1213-
dc.identifier.epage1222-
dc.identifier.eissn1533-4406-
dc.identifier.isiWOS:000351585900007-

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