CABG associated with lower mortality rates than PCI with drug-eluting stents

Coronary artery bypass grafting (CABG) has been found to be associated with lower mortality rates compared with percutaneous coronary intervention (PCI) using drug-eluting stents among patients with multivessel coronary artery disease (CAD). The two primary intervention options for patients with multivessel CAD are CABG and PCI. While several studies have compared the long-term outcomes of stenting and CABG, these studies preceded the introduction of drug-eluting stents, and little additional comparative data has subsequently become available. Consequently, it is unclear if the existing evidence is reflective of the relative outcomes of current practice using drug-eluting stents. This is particularly relevant given the recent emergence of reports warning of a potential danger associated with late stent thrombosis among patients with drug-eluting stents. Hannan et al. sought to compare the rates of death, death or myocardial infarction (MI), and subsequent revascularisation among patients receiving drug-eluting stents with those undergoing CABG. Their study included patients with multivessel disease who were treated with drug-eluting stents (with or without other devices, n = 9963) or CABG (n = 7437) in New York State from 1 October, 2003 to 31 December, 2004. The results revealed that CABG was associated with lower rates of death, and death or MI at 18-months post intervention for patients with both two- and three-vessel disease. The adjusted survival rates for patients with three-vessel disease who underwent CABG or received a stent were 94.0% versus 92.7%, respectively (p=0.03), and the adjusted survival rates free from MI were 92.1% and 89.7%, respectively (p<0.001). For patients with two-vessel disease the adjusted survival rates were 96.0% and 94.6%, respectively (p=0.003), and the adjusted survival rate free from MI were 94.5% versus 92.5%, respectively (p<0.001). Furthermore, rates of repeat revascularisation were found to be lower among patients undergoing CABG. In a related editorial, Dr Joseph Carrozza stated that the results of the study by Hannan et al. provide valuable guidance regarding the off-label use of drug-eluting stents. “The New York State registries are a sobering reality check for those who hoped the benefits of drug elution would level the playing field between CABG and stents for patients with multivessel disease,” he said. However, he proceeded to warn that the study — being observational — is prone to bias from physician and patients, and that this should also be taken into consideration. Reference...