title: Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both).
  
  
  METHODS
  We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry.
  
  
  RESULTS
  Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003).
  
  
  CONCLUSIONS
  CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (ClinicalTrials.gov number, NCT00114972.)
authors.affiliation: Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. p.w.j.c.serruys@erasmusmc.nl
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: Ted E
authors.initials: TE
authors.lastname: Feldman
authors.forename: Marcel
authors.initials: M
authors.lastname: van den Brand
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bass
authors.forename: Nic
authors.initials: N
authors.lastname: Van Dyck
authors.forename: Katrin
authors.initials: K
authors.lastname: Leadley
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000145:classification / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011446:Prospective Studies; D019233:Retreatment / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome