Faculty Collaboration Database

Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg 2006 Oct;82(4):1420-8; discussion 1428-9

Date

09/26/2006

Pubmed ID

16996946

DOI

10.1016/j.athoracsur.2006.04.044

Scopus ID

2-s2.0-33748943790 (requires institutional sign-in at Scopus site)   157 Citations

Abstract

BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG).

METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting.

RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD.

CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.

Author List

Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH Jr, Peterson ED, Jones RH

MESH terms used to index this publication - Major topics in bold

Aged
Angioplasty, Balloon, Coronary
Cardiovascular Agents
Coronary Artery Bypass
Coronary Stenosis
Female
Humans
Male
Prospective Studies
Risk Factors
Survival Analysis
Time Factors
Treatment Outcome