Coronary artery bypass grafting produces better outcomes than drug-eluting coronary stents do in patients with multivessel disease, according to a database study.
Given recent reports of the danger of late stent thrombosis with the drug-eluting devices, it wasn't clear “whether the relative outcomes reported in earlier studies that compared coronary artery bypass grafting (CABG) with coronary stenting are reflective of current practice.” Most of those studies were done comparing CABG with bare metal stents.
So Dr. Edward L. Hannan of the State University of New York at Albany and his associates used public health databases to compare outcomes between 9,963 state residents who received multiple drug-eluting stents via percutaneous coronary intervention and 7,437 who underwent CABG between October 2003 and December 2004. They followed all subjects through the end of 2005 and presented their report in the Jan. 24 issue of the New England Journal of Medicine.
Patients who received stents had a lower survival rate at 18 months (93%) than did those who underwent CABG (94%), as well as lower rates of the combined end point of freedom from MI or death (88% vs. 92%, respectively).
Outcomes were superior with CABG regardless of whether patients had proximal left anterior descending artery disease. And there was a trend favoring CABG in three high-risk subgroups of patients: those with diabetes, those with left ventricular ejection fractions below 40%, and those aged 80 and older, Dr. Hannan and his associates said (N. Engl. J. Med. 2008;358:331–41).
In an accompanying editorial comment, Dr. Joseph P. Carrozza Jr. of Harvard Medical School, Boston, said, “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.” Instead, the results “affirm that CABG remains the standard of care for patients who require multivessel coronary revascularization,” he said (New Engl. J. Med. 2008;358:405–7).