Long-term mortality of coronary artery bypass grafting and bare-metal stenting.
BACKGROUND
There is little information on relative survival with follow-up longer than 5 years in patients undergoing coronary artery bypass grafting (CABG) and patients undergoing percutaneous coronary intervention (PCI) with stenting. This study tested the hypothesis that CABG is associated with a lower risk of long-term (8-year) mortality than is stenting with bare-metal stents for multivessel coronary disease.


METHODS
We identified 18,359 patients with multivessel disease who underwent isolated CABG and 13,377 patients who received bare-metal stenting in 1999 to 2000 in New York and followed their vital status through 2007 using the National Death Index (NDI). We matched CABG and stent patients on the number of diseased coronary vessels, proximal left anterior descending (LAD) artery disease, and propensity of undergoing CABG based on numerous patient characteristics and compared survival after the 2 procedures.


RESULTS
In the 7,235 pairs of matched patients, the overall 8-year survival rates were 78.0% for CABG and 71.2% for stenting (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.64 to 0.74; p < 0.001). For anatomic groups classified by the number of diseased vessels and proximal LAD involvement, the HRs ranged from 0.53 (p < 0.001) for patients with 3-vessel disease involving proximal LAD artery disease to 0.78 (p = 0.05) for patients with 2-vessel disease but no disease in the LAD artery. A lower risk of death after CABG was observed in all subgroups stratified by a number of baseline risk factors.


CONCLUSIONS
Coronary artery bypass grafting is associated with a lower risk of death than is stenting with bare metal stents for multivessel coronary disease.
Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania 17033, USA. chuntao.wu@psu.edu
Chuntao
C
Wu
Songyang
S
Zhao
Andrew S
AS
Wechsler
Stephen
S
Lahey
Gary
G
Walford
Alfred T
AT
Culliford
Jeffrey P
JP
Gold
Craig R
CR
Smith
David R
DR
Holmes
Spencer B
SB
King
Robert S D
RS
Higgins
Desmond
D
Jordan
Edward L
EL
Hannan
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate