Robert A. Guyton, MD The Annals of Thoracic Surgery

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Presentation transcript:

Coronary Artery Bypass is Superior to Drug-Eluting Stents in Multivessel Coronary Artery Disease⁎ Robert A. Guyton, MD The Annals of Thoracic Surgery Volume 81, Issue 6, Pages 1949-1957 (June 2006) DOI: 10.1016/j.athoracsur.2006.03.020 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 In the Bypass Angioplasty Revascularization Investigation, the 7-year mortality rate was 16.6% for coronary artery bypass graft surgery (CABG) and 19.1% for percutaneous transluminal coronary angioplasty (PTCA [p = 0.043]). Relative to CABG, PTCA mortality was 15% higher [8]. The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Meta-analysis of nine randomized controlled trials: percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft surgery (CABG) in multivessel disease. (pts = patients.) (Reprinted from J Am Coll Cardiol, 41, Hoffman SN et al, A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes, 1293–304, copyright 2003, with permission from American College of Cardiology Foundation [10].) The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Data from meta-analysis of nine randomized controlled trials of coronary artery bypass graft surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) in multivessel disease. The 8-year mortality rate was 13.7% with CABG versus 17.1% with PTCA (p < 0.03). Relative mortality with PTCA was 25% higher than with CABG [10]. The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Forest plot of mortality from trials comparing drug-eluting stents (DES) with bare metal stents (BMS). (Reprinted from The Lancet, 364, Babapulle MN, A hierarchical Bayesian meta-analysis of randomized clinical trials of drug-eluting stents, 583–91, copyright 2004, with permission from Elsevier [19].) The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Forest plot of myocardial infarction from trials comparing drug-eluting stents (DES) with bare metal stents (BMS). (Reprinted from The Lancet, 364, Babapulle MN, A hierarchical Bayesian meta-analysis of randomized clinical trials of drug-eluting stents, 583–91, copyright 2004, with permission from Elsevier [19].) The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Adjusted 3-year mortality for initial coronary artery bypass graft surgery (CABG [gray bars]) versus initial stenting (black bars). Data for patients with nonproximal left anterior descending artery (LAD) disease obtained from Dr Michael J. Racz [23], University at Albany, State University of New York. (2VD = two-vessel disease; 3VD = three-vessel disease; prox = proximal.) The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Relative excess mortality at 3 years with initial stenting versus initial coronary artery bypass graft surgery (CABG). Data for patients with nonproximal left anterior descending artery (LAD) disease obtained from Dr Michael J. Racz [23], University at Albany, State University of New York. (2VD = two-vessel disease; 3VD = three-vessel disease; prox = proximal.) The Annals of Thoracic Surgery 2006 81, 1949-1957DOI: (10.1016/j.athoracsur.2006.03.020) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions