title: Multiple arterial grafting confers survival advantage compared to percutaneous intervention with drug-eluting stents in multivessel coronary artery disease: A propensity score adjusted analysis.
abstract: BACKGROUND
  The best revascularisation strategy for multivessel coronary artery disease (MVD) is still controversial. Percutaneous coronary intervention (PCI) utilising drug eluting stents (DES) has emerged as an acceptable alternative to conventional coronary artery bypass grafting (CABG) in the last decade. However, multiple arterial grafting (MAG) is superior revascularisation strategy compared with conventional CABG utilising single internal mammary artery and currently there is a paucity of comparison of DES and MAG. We aimed to investigate whether MAG offers advantage over DES-PCI in MVD.
  
  
  METHODS
  A total of 6126 patients with MVD (≥ 2 vessel) underwent CABG (n = 4652) or PCI (n = 1474) at a single institution. MAG was performed in 1372 CABG cases and DES were implanted in 1222 PCI cases. Propensity score adjusted analysis was performed to investigate the potential survival advantage of MAG over PCI. Mean follow-up was 4.9 years.
  
  
  RESULTS
  Risk for late death was comparable after DES-PCI and conventional CABG (HR 1.11; 95%CI 0.9 to 1.33; P = 0.25). However, DES-PCI was associated with an increased risk for late death compared to MAG (HR 1.53; 95%CI 1.08 to 2.91; P = 0.02). DES-PCI was also associated with a 3.51 fold increased risk for repeat revascularisation over MAG (95%CI 2.60 to 4.75; P < 0.0001) and 2.66 fold increased risk for repeat revascularisation over conventional CABG (95%CI 2.11 to 3.36; P < 0.0001).
  
  
  CONCLUSIONS
  MAG improved late survival and offered superior freedom from repeat revascularisation compared to DES-PCI. When feasible, MAG should be strongly recommended in patients with MVD.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Electronic address: drrajashahzad@hotmail.com.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Ilsley
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Arterial grafting; Bare metal stents; Coronary artery bypass grafting; Coronary artery disease; Drug-eluting stents