1. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease
- Author
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Nic Van Dyck, Katrin Leadley, Marie-Claude Morice, Eric Bass, Ted Feldman, Antonio Colombo, Elisabeth Ståhle, A. Pieter Kappetein, Friedrich W. Mohr, Keith D. Dawkins, Michael J. Mack, Patrick W. Serruys, David R. Holmes, Marcel van den Brand, Boston Scientif, Cardiology, and Cardiothoracic Surgery
- Subjects
Male ,Hybrid coronary revascularization ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Revascularization ,Klinikai orvostudományok ,Severity of Illness Index ,Coronary artery disease ,Internal medicine ,Angioplasty ,medicine ,Humans ,Myocardial infarction ,Prospective Studies ,cardiovascular diseases ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Aged ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,Orvostudományok ,Middle Aged ,medicine.disease ,Surgery ,Stroke ,Treatment Outcome ,surgical procedures, operative ,Drug-eluting stent ,Cardiovascular Diseases ,Conventional PCI ,Retreatment ,Cardiology ,Female ,business - Abstract
Background Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). Methods We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1: 1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point - a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. Results Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P = 0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P
- Published
- 2009