title: Long-term outcomes of drug-eluting stent implantation versus coronary artery bypass grafting for patients with coronary artery disease and chronic left ventricular systolic dysfunction.
abstract: Limited data are available on comparing the clinical outcomes of coronary artery bypass grafting (CABG) and drug-eluting stent (DES) implantation in patients with reduced left ventricular systolic function in the DES era. From January 2003 to December 2010, 953 patients with reduced left ventricular systolic function, defined as a left ventricular ejection fraction <50%, who had undergone percutaneous coronary intervention with DESs (n = 402) or CABG (n = 551) were enrolled in a retrospective, observational registry. Patients with acute myocardial infarction were excluded. Propensity score-matching analysis was also performed in 141 patient pairs. The primary outcome was all-cause death. The median follow-up duration was 32 months (interquartile range 15 to 61). All-cause death occurred in 81 patients (20.1%) in the DES group and 98 patient (17.8%) in the CABG group (p = 0.524). After propensity score matching, the long-term cumulative rate of death was not significantly different between the 2 groups (DES vs CABG 21.3% vs 19.1%; adjusted hazard ratio 1.23, 95% confidence interval 0.57 to 2.66, p = 0.603). However, the rate of major adverse cardiac and cerebrovascular events (35.5% vs 24.1%, adjusted hazard ratio 1.69, 95% confidence interval 1.04 to 2.77, p = 0.036) was higher in the DES group than the CABG group. This was driven by the higher incidence of repeat revascularization in the DES group (11.3% vs 4.3%, adjusted hazard ratio 3.65, 95% confidence interval 1.01 to 10.37, p = 0.018). In conclusion, DES implantation provides comparable long-term clinical outcomes, except for repeat revascularization, to CABG in patients with coronary artery disease and chronic left ventricular systolic dysfunction.
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Jeong
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications*