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Anyone read this yet? Here's the abstract. Any thoughts...
N Engl J Med. 2005 May 26;352(21):2174-83.
BACKGROUND: Several studies have compared outcomes for coronary-artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI), but most were
done before the availability of stenting, which has revolutionized the latter
approach. METHODS: We used New York's cardiac registries to identify 37,212
patients with multivessel disease who underwent CABG and 22,102 patients with multivessel disease who underwent PCI from January 1, 1997, to December 31, 2000. We determined the rates of death and subsequent revascularization within
three years after the procedure in various groups of patients according to the
number of diseased vessels and the presence or absence of involvement of the
left anterior descending coronary artery. The rates of adverse outcomes were
adjusted by means of proportional-hazards methods to account for differences in
patients' severity of illness before revascularization. RESULTS: Risk-adjusted
survival rates were significantly higher among patients who underwent CABG than
among those who received a stent in all of the anatomical subgroups studied. For example, the adjusted hazard ratio for the long-term risk of death after CABG
relative to stent implantation was 0.64 (95 percent confidence interval, 0.56
to 0.74) for patients with three-vessel disease with involvement of the
proximal left anterior descending coronary artery and 0.76 (95 percent
confidence interval, 0.60 to 0.96) for patients with two-vessel disease with
involvement of the nonproximal left anterior descending coronary artery. Also,
the three-year rates of revascularization were considerably higher in the
stenting group than in the CABG group (7.8 percent vs. 0.3 percent for
subsequent CABG and 27.3 percent vs. 4.6 percent for subsequent PCI).
CONCLUSIONS: For patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting.
N Engl J Med. 2005 May 26;352(21):2174-83.
BACKGROUND: Several studies have compared outcomes for coronary-artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI), but most were
done before the availability of stenting, which has revolutionized the latter
approach. METHODS: We used New York's cardiac registries to identify 37,212
patients with multivessel disease who underwent CABG and 22,102 patients with multivessel disease who underwent PCI from January 1, 1997, to December 31, 2000. We determined the rates of death and subsequent revascularization within
three years after the procedure in various groups of patients according to the
number of diseased vessels and the presence or absence of involvement of the
left anterior descending coronary artery. The rates of adverse outcomes were
adjusted by means of proportional-hazards methods to account for differences in
patients' severity of illness before revascularization. RESULTS: Risk-adjusted
survival rates were significantly higher among patients who underwent CABG than
among those who received a stent in all of the anatomical subgroups studied. For example, the adjusted hazard ratio for the long-term risk of death after CABG
relative to stent implantation was 0.64 (95 percent confidence interval, 0.56
to 0.74) for patients with three-vessel disease with involvement of the
proximal left anterior descending coronary artery and 0.76 (95 percent
confidence interval, 0.60 to 0.96) for patients with two-vessel disease with
involvement of the nonproximal left anterior descending coronary artery. Also,
the three-year rates of revascularization were considerably higher in the
stenting group than in the CABG group (7.8 percent vs. 0.3 percent for
subsequent CABG and 27.3 percent vs. 4.6 percent for subsequent PCI).
CONCLUSIONS: For patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting.