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


CONCLUSIONS
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.
Unger
Felix
F
Klinik ruer Herzchirurgie, Landeskliniken Salzburg, Austria. f.unger@lks.at
Serruys
Patrick W
PW
Yacoub
Magdi H
MH
Ilsley
Charles
C
Paulsen
Peter Kildeberg
PK
Nielsen
Torsten Toftegaard
TT
Eysmann
Leon
L
Kiemeneij
Ferdinand
F
D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome