title: Very Long-Term (10 to 14 Year) Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in the Bare-Metal Stent Era.
abstract: Many of the previous randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease reported equivalent or better survival with CABG as compared with PCI at 5-year follow-up. However, 5-year follow-up might be too short to evaluate the true differences in long-term clinical outcomes between PCI and CABG.
  
  
  
  Among 8934 patients enrolled in the extended 10- to 14-year follow-up study of the CREDO-Kyoto registry cohort-1 (Coronary Revascularization Demonstrating Outcome study in Kyoto) conducted in the bare-metal stent era, 5152 (PCI: n=3490 and CABG: n=1662) patients had multivessel coronary artery disease without left main disease. Median follow-up duration was 11.2 (interquartile range: 10.2-12.2) years. The cumulative 10-year incidence of all-cause death was not significantly different between PCI and CABG (32.2% versus 31.7%; log-rank P=0.93). After adjusting for confounders, however, the mortality risk of PCI was significantly higher than that of CABG (hazard ratio, 1.19 [95% confidence interval, 1.02-1.39]; P=0.03). Within 5 years after the index procedure, the risk for all-cause death was significantly higher after PCI than after CABG (hazard ratio, 1.41; 95% CI, 1.12-1.79; P=0.004). By a landmark analysis at 5 years, however, the cumulative 10-year incidence of and adjusted risk for all-cause death beyond 5 years were not significantly different between PCI and CABG (19.3% versus 20.0%; log-rank P=0.22 and hazard ratio, 1.02, 95% confidence interval, 0.83-1.26; P=0.82).
  
  
  
  CABG as compared with PCI was associated with better 10-year survival in patients with multivessel coronary artery disease. However, the benefit of CABG compared with PCI on late mortality beyond 5 years was not observed in this study.
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Hiroki
authors: H
authors: Shiomi
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Kyohei
authors: K
authors: Yamaji
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Takeshi
authors: T
authors: Morimoto
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Satoshi
authors: S
authors: Shizuta
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Kenji
authors: K
authors: Nakatsuma
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Hirooki
authors: H
authors: Higami
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Yutaka
authors: Y
authors: Furukawa
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Yoshihisa
authors: Y
authors: Nakagawa
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Kazushige
authors: K
authors: Kadota
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Kenji
authors: K
authors: Ando
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Ryuzo
authors: R
authors: Sakata
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Hitoshi
authors: H
authors: Okabayashi
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Michiya
authors: M
authors: Hanyu
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Mitsuomi
authors: M
authors: Shimamoto
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Noboru
authors: N
authors: Nishiwaki
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
authors: Tatsuhiko
authors: T
authors: Komiya
authors: From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.). taketaka@kuhp.kyoto-ua.ac.jp.
authors: Takeshi
authors: T
authors: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D057216:Propensity Score; D015607:Stents
keywords: cohort study; coronary artery disease; follow-up studies; saphenous vein; stents