title: Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery.
abstract: Guidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials.
  
  
  
  Patients with multivessel disease and severe left ventricular systolic dysfunction (ejection fraction ≤35%) who underwent either PCI with everolimus-eluting stent or CABG were selected from the New York State registries. The primary outcome was long-term all-cause death. Secondary outcomes were individual outcomes of myocardial infarction, stroke, and repeat revascularization. Among the 4616 patients who fulfilled our inclusion criteria (1351 everolimus-eluting stent and 3265 CABG), propensity score matching identified 2126 patients with similar propensity scores. In the short term, PCI was associated with a lower risk of stroke (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.01-0.39; P=0.004) in comparison with CABG. At long-term follow-up (median, 2.9 years), PCI was associated with a similar risk of death (HR, 1.01; 95% CI, 0.81-1.28; P=0.91), a higher risk of myocardial infarction (HR, 2.16; 95% CI, 1.42-3.28; P=0.0003), a lower risk of stroke (HR, 0.57; 95% CI, 0.33-0.97; P=0.04), and a higher risk of repeat revascularization (HR, 2.54; 95% CI, 1.88-3.44; P<0.0001). The test for interaction was significant (P=0.002) for completeness of revascularization, such that, in patients in whom complete revascularization was achieved with PCI, there was no difference in myocardial infarction between PCI and CABG.
  
  
  
  Among patients with multivessel disease and severe left ventricular systolic dysfunction, PCI with everolimus-eluting stent had comparable long-term survival in comparison with CABG. PCI was associated with higher risk of myocardial infarction (in those with incomplete revascularization) and repeat revascularization, and CABG was associated with higher risk of stroke.
authors.affiliation: From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.). sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
authors.forename: Zaza
authors.initials: Z
authors.lastname: Samadashvili
authors.affiliation: From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: From New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy
chemical_list: D000068338:Everolimus
keywords: coronary artery bypass; everolimus; percutaneous coronary intervention; ventricular dysfunction