Comparing the long-term outcomes of percutaneous coronary intervention with everolimus-eluting stents versus coronary artery bypass grafting in patients with mutltivessel coronary artery disease.

This study compared the long-term outcomes of percutaneous coronary intervention (PCI) using everolimus (Afinitor)-eluting stents (Xience) versus coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease (CAD). The data showed that both treatments were associated with a similar risk of heart attack, stroke, and death over the long term in these patients. However, PCI increased spontaneous heart attacks and repeat revascularization compared to CABG in these patients.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This reduces the blood flow to the heart. Multivessel coronary artery disease involves more than one of the major coronary arteries. It often requires aggressive surgical intervention in order to restore proper blood flow to the heart muscle.

PCI (or angioplasty) is a non-surgical procedure where narrow or blocked arteries are widened or unblocked. In some cases, a stent is implanted. A stent is a flexible tube that keeps the artery open. Drug-eluting stents (DES) also release medication into the body. These drugs prevent cells from gathering inside the stent and blocking it again. Everolimus is a drug that is used to coat stents.

CABG is a surgical procedure where a healthy blood vessel is taken (usually from the chest wall). This healthy vessel will be connected (‘grafted’) to the blocked artery. This creates a ‘bypass’ around the blocked artery. The long-term outcomes of PCI with everolimus-ES compared with CABG in patients with multivessel CAD remain unknown.

This study involved 880 patients with multivessel CAD. Patients were randomly assigned into 2 groups. Group 1 included 438 patients who received PCI with everolimus-ES. Group 2 included 442 patients who received CABG. The average follow-up time was 11.8 years.

At follow-up, the mortality rate for group 1 was 20.5%, and for group 2 was 19.9%. This difference was not statistically significant. There was also no significant difference between the two groups in terms of heart attacks or stroke rates (28.8% in group 1 vs 27.1% in group 2).

22.6% of patients in group 1 needed repeat revascularization (restoring the delivery of the blood to the heart) compared to 12.7% of patients in group 2. Patients in group 1 were 1.92 times more likely to have repeat revascularization compared to patients in group 2.

7.1% of patients in group 1 experienced spontaneous heart attacks compared to 3.8% of patients in group 2. Patients in group 1 were 1.86 times more likely to have spontaneous heart attacks compared to patients in group 2.

This study concluded that both PCI with everolimus-ES and CABG treatments were associated with a similar risk of heart attack, stroke, and death over the long term in patients with multivessel CAD. However, PCI increased spontaneous heart attacks and repeat revascularization compared to CABG in these patients.

This study was funded by Abbott Vascular, the manufacturer of Xience. The patients knew which treatment they were getting, which might affect the conclusions. This study included patients only from South Korea, China, Thailand, and Malaysia. Larger studies including different populations are necessary to validate the conclusions.