Wednesday, February 13, 2008

CABG Superior to Drug-Eluting Stents in Coronary Artery Disease

For patients with multi-vessel coronary blockage, Coronary Artery Bypass Grafting (CABG) has a lower 18-month mortality compared to Percutaneous Intervention with Drug Eluting Stents according to a study published January 24, 2008 in the New England Journal of Medicine. Edward Hannan and co-workers reviewed outcomes from the New York State Department of Health databases for 9963 patients who received drug-eluting stents (DES) and 7437 patients who underwent CABG between October 1, 2003 and December 31, 2004. The patients were followed until December 31, 2005. The risk-adjusted rate of death in eighteen months was 6.0% (CABG) versus 7.3% (DES) for patients with three vessel disease and was 4.0% (CABG) versus 5.4% (DES) for patients with two vessel blockage. Both these differences were statistically significant (p<.03 and P<.003 respectively).

These results favoring CABG over DES are not surprising. They are consistent with earlier studies comparing CABG with Bare Metal Stents (BMS). It has been shown that there is no survival benefit or myocardial infarction benefit with DES compared to BMS. What was surprising in this study was the high repeat procedure rate after DES; 30.6% of patients had repeat procedures within 18 months ( ~1/3 of these may have been planned staged procedures).

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