title: Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.
abstract: BACKGROUND
  Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease.
  
  
  RESULTS
  A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19).
  
  
  CONCLUSIONS
  Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes. Coronary artery bypass surgery may be the preferred revascularization strategy in diabetic patients with multivessel coronary artery disease.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Aamir
authors.initials: A
authors.lastname: Javaid
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Ashesh N
authors.initials: AN
authors.lastname: Buch
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Corso
authors.forename: Steven W
authors.initials: SW
authors.lastname: Boyce
authors.forename: Tina L
authors.initials: TL
authors.lastname: Pinto Slottow
authors.forename: Probal K
authors.initials: PK
authors.lastname: Roy
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Smith
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Natalie
authors.initials: N
authors.lastname: Gevorkian
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000639:trends*; D001026:Coronary Artery Bypass / Q000379:methods / Q000639:trends*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome