Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease

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• 作者：Mineok Chang ; MD^a ; Jung-Min Ahn ; MD^a ; Cheol Whan Lee ; MD^a ; ^{cheolwlee@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Rafael Cavalcante ; MD^b ; Yohei Sotomi ; MD^c ; Yoshinobu Onuma ; MD^b ; Erhan Tenekecioglu ; MD^b ; Minkyu Han ; PhD^d ; Duk-Woo Park ; MD^a ; Soo-Jin Kang ; MD^a ; Seung-Whan Lee ; MD^a ; Young-Hak Kim ; MD^a ; Seong-Wook Park ; MD ; PhD^a ; Patrick W. Serruys ; MD ; PhD^b ; ^e ; Seung-Jung Park ; MD ; PhD^a
• 关键词：coronary artery bypass graft surgery ; drug-eluting stents ; multivessel coronary artery disease
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：5 July 2016
• 年：2016
• 卷：68
• 期：1
• 页码：29-36
• 全文大小：891 K

文摘

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.

Objectives

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.

Methods

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.

Results

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).

Conclusions

CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.