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Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Disease

Sunday, March 29, 2015

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Source Name: New England Journal of Medicine


Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL.

The authors of this article compared CABG and PCI with second generation drug eluting stents (DES-PCI) in patients with multivessel coronary artery disease. They used data from a large observational registry and applied propensity score matching to create groups with similar baseline characteristics. They found that, at a mean follow-up of almost 3 years, DES-PCI and CABG had a similar risk of all-cause death (3.1% per year versus 2.9% per year, p=0.50), but a higher risk of myocardial infarction (1.9% per year vs. 1.1% per year; p<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year, p<0.001). The risk of stroke was lower with DES-PCI (0.7% per year vs. 1.0% per year, p<0.001). The higher risk of myocardial infarction seemed to be restricted to those DES-PCI patients in whom there was incomplete revascularization.  The authors conclude that the 3-year mortality risk between second generation DES-PCI and CABG was similar. DES-PCI was associatied with higher risk of myocadial infarction and repeat revascularization, but had a lower risk of stroke.

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