Initial impact of drug-eluting stents on coronary artery bypass graft surgery.
BACKGROUND
Drug-eluting stents (DES) reduce the incidence of restenosis after percutaneous coronary intervention and have been predicted to decrease the number of patients referred for coronary artery bypass grafting (CABG). The purpose of this study was to determine the impact of DES on the number and characteristics of patients referred for CABG.


METHODS
Drug-eluting stents were introduced at our hospital in April 2003 and reached maturity by June 2003. We compared our isolated CABG patients from the 12 months before the introduction of DES (year 1) with those from the 12 months after full implementation of DES (year 2).


RESULTS
In year 1, of 4,348 cardiac catheterization patients, 2,144 (49.3%) underwent percutaneous coronary intervention, and 432 (9.9%) had CABG. In year 2, of 3,986 cardiac catheterization patients, 2,027 (50.9%) had percutaneous coronary intervention, and 337 (8.5%) had CABG, representing a 14% reduction in proportion of cardiac catheterization patients referred for CABG (p = 0.021). Among CABG patients, there was no change in age, prevalence of diabetes, or prevalence of three-vessel disease; however, patients in year 2 were more likely to have left main coronary artery disease (year 1, 36% versus year 2, 44.5%; p < 0.02) and left ventricular ejection fraction greater than 0.50 (year 1, 45% versus year 2, 52%; p < 0.02).


CONCLUSIONS
The clinical introduction of DES was associated with a modest decrease in the percentage of cardiac catheterization patients referred for CABG. Of those referred for surgery, an increasing proportion had left main coronary artery disease and preserved left ventricular systolic function. Defining the role of DES versus CABG for coronary revascularization will require elucidation of the long-term outcomes of DES compared with CABG.
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. john_liddicoat@bidmc.harvard.edu
John R
JR
Liddicoat
Ralph
R
De La Torre
Kalon K L
KK
Ho
Senthil
S
Nathan
Sidney
S
Levitsky
Judy
J
Krempin
Frank
F
Sellke
D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015607:Stents