title: Comparative effectiveness of revascularization strategies.
abstract: BACKGROUND
  Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG.
  
  
  METHODS
  We linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias.
  
  
  RESULTS
  Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group; risk ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%; risk ratio, 0.79; 95% CI, 0.76 to 0.82). Similar results were noted in multiple subgroups and with the use of several different analytic methods. Residual confounding was assessed by means of a sensitivity analysis.
  
  
  CONCLUSIONS
  In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI. (Funded by the National Heart, Lung, and Blood Institute.).
authors.affiliation: Christiana Care Health System, Newark, DE 19718, USA. wweintraub@christianacare.org
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Weiss
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.forename: Zugui
authors.initials: Z
authors.lastname: Zhang
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Charles
authors.initials: C
authors.lastname: McKay
authors.forename: Laura L
authors.initials: LL
authors.lastname: Ritzenthaler
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Shewan
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
authors.forename: Issam D
authors.initials: ID
authors.lastname: Moussa
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D057186:Comparative Effectiveness Research; D015986:Confounding Factors, Epidemiologic; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019370:Observation; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014481:United States