Coronary artery bypass is superior to drug-eluting stents in multivessel coronary artery disease.
Percutaneous intervention for the treatment of multivessel coronary artery disease continues to displace coronary artery bypass graft surgery. But controlled trials of percutaneous intervention versus coronary bypass, in meta-analysis, have shown a significant survival advantage for coronary bypass. Studies of bare metal stents have not presented any data to prompt reversal of this conclusion for all but the small portion of patients most suited for stenting. Drug-eluting stents have no survival advantage compared with bare metal stents. Data from real-world registries have shown that the current therapy of multivessel disease patients has resulted in a relative excess mortality of as much as 46% in patients with initial stenting compared with patients with initial coronary bypass. Ethical considerations demand that patients with multivessel disease be informed of the documented mortality benefit of coronary bypass graft surgery.
Guyton
Robert A
RA
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery* / Q000628:therapy; D023903:Coronary Restenosis / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D004343:Drug Implants; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009656:North America / Q000453:epidemiology; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000401:mortality; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014342:Truth Disclosure
D004343:Drug Implants