Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease
| Autor: | Robert S.D. Higgins, Alfred T. Culliford, Jeffrey P. Gold, Chuntao Wu, Gary Walford, Edward L. Hannan, Russell E. Carlson, Robert H. Jones, Craig R. Smith |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction New York Coronary Disease Observation Coronary Restenosis Postoperative Complications Risk Factors Internal medicine Angioplasty Myocardial Revascularization medicine Humans cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Coronary Artery Bypass Survival rate Survival analysis Aged Proportional Hazards Models Retrospective Studies Aged 80 and over business.industry Proportional hazards model Hazard ratio Stent Drug-Eluting Stents General Medicine Middle Aged medicine.disease Survival Analysis Surgery Drug-eluting stent Cardiology Female business |
| Zdroj: | New England Journal of Medicine. 358:331-341 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents.We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients.In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P0.001). Patients undergoing CABG also had lower rates of repeat revascularization.For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization. |
| Databáze: | OpenAIRE |
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