ALBANY, N.Y. (January 23, 2008) -- A report by University at Albany researchers and their colleagues concludes that for heart patients with multiple blockages, coronary-artery bypass grafting (CABG) surgery is a more effective treatment than treatment with drug-eluting stents. Bypass treatment incurs lower mortality rates and is also associated with lower rates of myocardial infarction (heart attack) and repeat revascularization.
The report, published in the January 24, 2008 issue of the New England Journal of Medicine, examined data from 17,400 patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003 and December 31, 2004, and compared their outcomes (death, death or myocardial infarction, or repeat revascularization) through the end of 2005.
"We recommend that patients and their referring physicians take these findings into account along with patient preferences and other considerations when deciding on the treatment for multivessel coronary artery disease," said Dr. Edward Hannan, principal author of the study and a Distinguished Professor and associate dean for research at the University at Albany School of Public Health. "Furthermore, there is an urgent need to identify precisely which patients fare as well or better with stenting as with CABG surgery."
In comparing treatment with a drug-eluting stents, a procedure which has been used since 2003, researchers found that CABG surgery was associated with significantly lower 18-month rates of death or heart attacks for patients with both three-vessel disease and two-vessel disease. The patients with three-vessel disease who underwent CABG experienced an adjusted survival rate of 94 percent compared with those who received a drug-eluting stent, who survived at a rate of 92.7 percent. In addition, the adjusted rate of survival free from myocardial infarction was 92.1 percent for those treated with CABG, versus 89.7 percent for those treated with drug-eluting stents. Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted survival rate was 96.0 percent versus 94.6 percent, while the adjusted rate of survival free from myocardial infarction was 94.5 percent for CABG patients versus 92.5 percent who received drug-eluting stents. Patients treated by CABG also showed lower rates of repeat revascularization.
View the report.