title: Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease.
abstract: In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients.
  
  
  
  This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD.
  
  
  
  Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause.
  
  
  
  The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001).
  
  
  
  CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Mineok
authors.initials: M
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. Electronic address: cheolwlee@amc.seoul.kr.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Erasmus University Medical Center, Amsterdam, the Netherlands.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavalcante
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sotomi
authors.affiliation: Erasmus University Medical Center, Amsterdam, the Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Erasmus University Medical Center, Amsterdam, the Netherlands.
authors.forename: Erhan
authors.initials: E
authors.lastname: Tenekecioglu
authors.affiliation: Division of Biostatistics, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Minkyu
authors.initials: M
authors.lastname: Han
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Erasmus University Medical Center, Amsterdam, 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: Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D013997:Time Factors
keywords: coronary artery bypass graft surgery; drug-eluting stents; multivessel coronary artery disease