title: Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease.
abstract: BACKGROUND
  In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.
  
  
  METHODS
  From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.
  
  
  RESULTS
  At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.
  
  
  CONCLUSIONS
  Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Chang-sheng
authors.initials: CS
authors.lastname: Ma
authors.forename: Jun-ping
authors.initials: JP
authors.lastname: Kang
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.forename: Yu-jie
authors.initials: YJ
authors.lastname: Zhou
authors.forename: Shu-zheng
authors.initials: SZ
authors.lastname: Lü
authors.forename: Fang-jiong
authors.initials: FJ
authors.lastname: Huang
authors.forename: Cheng-xiong
authors.initials: CX
authors.lastname: Gu
authors.forename: Xiao-ling
authors.initials: XL
authors.lastname: Zhu
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002908:Chronic Disease; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy; D054059:Coronary Occlusion / Q000601:surgery / Q000628:therapy; D054855:Drug-Eluting Stents; D006801:Humans; D011446:Prospective Studies