Heart Care Info - Heart Disease Prevention & Treatment

Nonrandomized Data on Drug-Eluting Stents Compared With Coronary Bypass Surgery: Caution With Interpretation

SJ Head, AJJC Bogers... - Journal of the American ..., 2011 - Am Coll Cardio Found REFERENCES 1. Elias-Smale SE, Proenca RV, Koller MT, et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol 2010;56:140714. 2. Mc Evoy JW. Coronary artery calcium score and cardiovascular ...

Stuart J. Head, B Sc, Ad J.J.C. Bogers, MD, Ph D and A. Pieter Kappetein, MD, Ph D*

In a recent issue of the Journal, Park et al. (1) presented long-term follow-up results from the Asan-Multivessel Registry in which patients are followed after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for the treatment of multivessel coronary artery disease. After 5 years, similar rates of death or the composite endpoint of death, myocardial infarction, or stroke were found in the DES and CABG groups. This is the first paper to compare these groups after such long follow-up, but it should be highlighted that this is a nonrandomized study. To date, only the SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trial compared patients randomized to DES or CABG and after 1 year already showed that DES failed to reach noninferiority to CABG (2). A possible explanation for the contradicting results of Park et al. (1) is that apart from baseline characteristics (age, sex, body mass index) and comorbid conditions (hypertension, hyperlipidemia, diabetes requiring insulin, heart failure, prior myocardial infarction), the severity of multivessel disease is less worse than in the SYNTAX trial (Table 1), with an overall SYNTAX coronary score that is much lower in the DES group (SYNTAX trial 28.4% vs. 17.4% in the present study). The SYNTAX trial also included more than twice as many patients with a left main lesion; these patients have been identified as having the worst prognosis (3). Furthermore, CABG has always shown a better prognosis in patients with more extensive coronary artery disease. Outcomes in the study by Parks et al. (1), therefore, represent results from a patient cohort in whom it is unlikely that an advantage of surgery could be demonstrated.