Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease.

BACKGROUND: The introduction of drug-eluting stents (DESs) has demonstrated superiority over the bare metal stent in reducing the incidence of restenosis. We investigated the clinical outcomes of DESs versus coronary artery bypass grafting (CABG) in a series of patients with multivessel disease.

METHODS: Patients with multivessel disease who underwent percutaneous coronary intervention with DESs (n = 441) or CABG (n = 390) between March 2003 and March 2005 were included. The primary outcomes of this study were defined as the absence of major adverse cardiac and cerebral events at 12 months, including death from any cause, cerebrovascular accidents, acute myocardial infarctions, and repeat revascularization after percutaneous coronary intervention with DESs or CABG.

RESULTS: During 12 months of follow-up, the mortality rate was also not significantly different between the two groups (2.1% versus 3.2%, p = 0.170). The incidences of composite death, cerebrovascular accident, and acute myocardial infarction were not significantly different between groups (2.8% versus 3.9%, p = 0.180). The rate of overall major adverse cardiac and cerebral events was higher in DES group compared with the CABG group (13.0% versus 4.2%, p < 0.001), as driven by the higher incidence of myocardial infarction and revascularization.

CONCLUSIONS: The incidences of death and cerebrovascular event were not significantly different between the DES and CABG groups in the patients with multivessel disease. However, the overall incidence of major adverse cardiovascular and cerebral events seems to be favorable for CABG group even this era of DESs.