title: Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction.
abstract: Patients with previous myocardial infarction (MI) have a high risk of recurrence. Little is known about the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with a previous MI and left main or multivessel coronary artery disease (CAD). We compared long-term outcomes of these 2 strategies in 672 patients with previous MI and left main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n = 323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was analyzed, and the primary outcome was a composite of death from any causes, MI, or stroke. Baseline characteristics were similar between the 2 groups. The median follow-up duration was 59.8 months. The rate of the primary outcome was significantly lower with CABG than PCI (hazard ratio [HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p <0.001). The benefit of CABG over PCI was consistent across all major subgroups. The individual risks of death from any causes or stroke were comparable between the 2 groups. Conversely, the rate of repeat revascularization was significantly lower with CABG than PCI (HR 0.34, 95% CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous MI and left main or multivessel CAD, compared to PCI with DES, CABG significantly reduces the risk of death from any causes, MI, or stroke.
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Mineok
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: cheolwlee@amc.seoul.kr.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavalcante
authors.affiliation: Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sotomi
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Yaping
authors.initials: Y
authors.lastname: Zeng
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; International Center for Circulatory Health, Imperial College of London, London, United Kingdom.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
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; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D016896:Treatment Outcome