Better outcomes with bypass surgery for multivessel disease


A study conducted in a single centre in Beijing, China, and published on 21 April 2009 in Circulation showed that, in a cohort of patients with multivessel disease, coronary artery bypass grafting was associated with lower rates of death, myocardial infarction, and target-vessel revascularisation than drug-eluting stents.

The researchers, led by Dr Shengshou Hu, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, identified 3,720 consecutive patients with multivessel disease who underwent isolated coronary artery bypass graft surgery or received drug-eluting stents between 1 April 2004 and 31 December 2005, and compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularisation) during a three-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent bypass graft (n=1,886) were older and had more comorbidities than patients who received drug-eluting stents (n=1,834).

The results showed that patients receiving drug-eluting stents had considerably higher three-year rates of target-vessel revascularisation. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the two groups (hazard ratio, .92; 95% confidence interval, .69 to 1.51).