title: Impact of drug-eluting stents on the comparative effectiveness of coronary artery bypass surgery and percutaneous coronary intervention.
abstract: BACKGROUND
  Drug-eluting stents (DES) have largely replaced bare-metal stents (BMS) for percutaneous coronary intervention (PCI). It is uncertain, however, whether introduction of DES had a significant impact on the comparative effectiveness of PCI versus coronary artery bypass graft surgery (CABG) for death and myocardial infarction (MI).
  
  
  METHODS
  We identified Medicare beneficiaries aged ≥66 years who underwent multivessel CABG or multivessel PCI and matched PCI and CABG patients on propensity score. We defined the BMS era as January 1999 to April 2003 and the DES era as May 2003 to December 2006. We compared 5-year outcomes of CABG and PCI using Cox proportional hazards models, adjusting for baseline characteristics and year of procedure and tested for a statistically significant interaction (P(int)) of DES era with treatment (CABG or PCI).
  
  
  RESULTS
  Five-year survival improved from the BMS era to the DES era by 1.2% for PCI and by 1.1% for CABG, and the CABG:PCI hazard ratio was unchanged (0.90 vs 0.90; P(int) = .96). Five-year MI-free survival improved by 1.4% for PCI and 1.1% for CABG, with no change in the CABG:PCI hazard ratio (0.81 vs 0.82; P(int) = .63). By contrast, survival-free of MI or repeat coronary revascularization improved from the BMS era to the DES era by 5.7% for PCI and 0.9% for CABG, and the CABG:PCI hazard ratio changed significantly (0.50 vs 0.57, P(int) ≤ .0001).
  
  
  CONCLUSIONS
  The introduction of DES did not alter the comparative effectiveness of CABG and PCI with respect to hard cardiac outcomes.
authors.affiliation: Stanford University School of Medicine, Stanford, CA. Electronic address: hlatky@stanford.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA; University of California San Francisco School of Medicine, San Francisco, CA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D016016:Proportional Hazards Models; D019233:Retreatment; D015607:Stents