title: Frequency of coronary artery bypass grafting following implantation of a paclitaxel-eluting or a bare-metal stent into a single coronary artery.
abstract: Limited data are available on the relative effect of drug-eluting versus bare-metal stents on the requirement for subsequent coronary artery bypass grafting (CABG). The aim of this study was to evaluate the incidence and predictors of CABG after bare-metal and paclitaxel-eluting coronary stent implantation. A patient-level, pooled analysis was conducted of 2,736 patients from 3 double-blind, randomized trials comparing the slow-release paclitaxel-eluting Taxus stent with an otherwise identical bare-metal stent control in single de novo coronary lesions, with 5-year follow-up. The rate of target lesion revascularization by CABG (TLR-CABG) was reduced from 4.1% in patients with bare-metal stents to 1.4% in those with Taxus stents (p <0.001). The use of the Taxus stent was the strongest predictor of freedom from TLR-CABG on multivariate analysis (hazard ratio 0.33, p <0.001). Significant reductions in TLR-CABG with Taxus compared with bare-metal stents were seen in the treatment of left anterior descending artery lesions (6.1% vs 1.8%, p <0.001) and non-left anterior descending artery lesions (2.8% vs 1.3%, p = 0.037), in patients with diabetes (6.0% vs 1.0%, p <0.01), and in those without diabetes (3.5% vs 1.6%, p <0.01). In conclusion, referral to CABG is significantly less common after stenting single coronary lesions with Taxus compared with bare-metal stents. The relative reductions in TLR-CABG of 54% in patients without diabetes, 87% in patients with diabetes, 70% in left anterior descending artery lesions, and 54% in non-left anterior descending artery lesions with Taxus compared with bare-metal stents should be considered during stent selection.
authors.affiliation: Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, USA. martinj@mlhs.org
authors.forename: Jack L
authors.initials: JL
authors.lastname: Martin
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Tom
authors.initials: T
authors.lastname: Maloney
authors.forename: Mark I
authors.initials: MI
authors.lastname: Friedman
authors.forename: Donald S
authors.initials: DS
authors.lastname: Baim
authors.forename: Keith
authors.initials: K
authors.lastname: Dawkins
authors.forename: Ron
authors.initials: R
authors.lastname: Caputo
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D001807:Blood Vessel Prosthesis; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D017239:Paclitaxel / Q000494:pharmacology*; D011379:Prognosis; D012086:Reoperation; D015607:Stents
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D020099:Coated Materials, Biocompatible; D017239:Paclitaxel