title: Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents.
abstract: BACKGROUND
  Few studies have examined differences in long-term mortality between coronary artery bypass graft surgery and stenting with drug-eluting stents (DES) for multivessel disease without left main coronary artery stenosis. This study compares the risks of long-term mortality between these 2 procedures during a follow-up of up to 5 years.
  
  
  METHODS
  Patients who underwent isolated bypass surgery (n=13,212) and stenting with DES (n=20,161) between October 2003 and December 2005 in New York State were followed for their vital status through 2008. To control for treatment selection bias, bypass and stenting patients were matched on age, number of diseased coronary vessels, presence of proximal or nonproximal left anterior descending (LAD) artery disease, and propensity of undergoing bypass surgery. Five-year survival rates for the 2 procedures were compared and hazard ratios for death of bypass surgery compared with stenting were obtained.
  
  
  RESULTS
  The respective 5-year survival rates in the 8,121 pairs of matched bypass and stenting patients were 80.4% and 73.6% (p<0.001), and the risk of death after bypass surgery was 29% lower than for stenting (hazard ratio = 0.71, 95% confidence interval: 0.67 to 0.77, p<0.001). Significantly lower risks of death for bypass surgery were observed in patients with LAD artery disease but not in patients without LAD artery disease. Significantly lower risks of death for bypass surgery were also found in all patient subgroups defined by the presence of selected baseline risk factors.
  
  
  CONCLUSIONS
  Bypass surgery is associated with lower risk of death than stenting with DES for multivessel disease without left main stenosis.
authors: Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey Pennsylvania 17033, USA. cwupub@gmail.com
authors: Chuntao
authors: C
authors: Wu
authors: Fabian T
authors: FT
authors: Camacho
authors: Songyang
authors: S
authors: Zhao
authors: Andrew S
authors: AS
authors: Wechsler
authors: Alfred T
authors: AT
authors: Culliford
authors: Stephen J
authors: SJ
authors: Lahey
authors: Spencer B
authors: SB
authors: King
authors: Gary
authors: G
authors: Walford
authors: Jeffrey P
authors: JP
authors: Gold
authors: Craig R
authors: CR
authors: Smith
authors: Desmond
authors: D
authors: Jordan
authors: Robert S D
authors: RS
authors: Higgins
authors: Edward L
authors: EL
authors: Hannan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
references: Circulation. 2009 Apr 21;119(15):2040-50
references: 19349321
references: J Am Coll Cardiol. 2005 Aug 16;46(4):582-8
references: 16098419
references: Ann Thorac Surg. 2011 Dec;92(6):2132-8
references: 22014747
references: Circulation. 2010 Sep 7;122(10):949-57
references: 20733102
references: J Thorac Cardiovasc Surg. 2011 May;141(5):1134-44
references: 21167508
references: Eur Heart J. 2011 Sep;32(17):2125-34
references: 21697170
references: Circulation. 2005 Aug 30;112(9 Suppl):I371-6
references: 16159849
references: Circulation. 2007 Sep 11;116(11 Suppl):I200-6
references: 17846304
references: N Engl J Med. 2008 Jan 24;358(4):331-41
references: 18216353
references: N Engl J Med. 2005 May 26;352(21):2174-83
references: 15917382
references: J Am Coll Cardiol. 2010 Mar 16;55(11):1093-101
references: 20171036
references: N Engl J Med. 2009 Mar 5;360(10):961-72
references: 19228612
references: J Am Coll Cardiol. 2005 Aug 16;46(4):575-81
references: 16098418
references: N Engl J Med. 2012 Apr 19;366(16):1467-76
references: 22452338
references: Circulation. 2007 Sep 11;116(11 Suppl):I226-31
references: 17846308
references: EuroIntervention. 2005 Aug;1(2):219-27
references: 19758907
references: Circulation. 2008 Jul 22;118(4):381-8
references: 18606919