Late outcome after stenting or coronary artery bypass surgery for the treatment of multivessel disease: A single-center controlled cohort study matched-propensity

Background. Although several randomized controlled trials examined the relative benefits of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI), the most appropriate treatment remains a matter of debate, at least in some subsets of patients. Therefore, we evaluated the 8-year outcome after multivessel stent implantation (stent group) or coronary artery bypass surgery (CABG group) in a single-center propensity-matched cohort study. Methods. The stent study population consisted of all 409 consecutive patients who underwent an elective coronary intervention between 1995 and 1999 in whom at least 2 stents were implanted in multiple vessels. They were matched by using the propensity score method with 409 CABG patients of 1,723 CABG patients with multivessel disease who underwent elective CABG in the same period of time. The two populations were very different before matching. After matching, the CABG population resembled a stent population. Results. The cumulative survival rates after stent were 93%, 90%, and 82% at, respectively, 3, 5, and 8 years; and after CABG 97%, 93%, and 87% (p = 0.02). This was caused mainly by patients with left main disease (p = 0.03). Event-free survival was only 70%, 68%, and 64% after stent and 89%, 82%, and 78% after CABG at, respectively, 3, 5, and 8 years (p < 0.0001). After adjusting, stent was an independent predictor of higher mortality. Conclusions. In this matched cohort study with an 8-year follow-up, survival was better and less repeat revascularizations were needed among patients undergoing elective CABG for the treatment of multivessel disease as compared with the stent group. (c) 2005 by The Society of Thoracic Surgeons.