Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.

Details

Serval ID
serval:BIB_21247
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.
Journal
New England Journal of Medicine
Author(s)
Serruys P.W., Unger F., Sousa J.E., Jatene A., Bonnier H.J., Schönberger J.P., Buller N., Bonser R., van den Brand M.J., van Herwerden L.A., Morel M.A., van Hout B.A.
Working group(s)
Arterial Revascularization Therapies Study Group
ISSN
0028-4793 (Print)
ISSN-L
0028-4793
Publication state
Published
Issued date
2001
Volume
344
Number
15
Pages
1117-1124
Language
english
Notes
Publication types: Clinical Trial ; Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
BACKGROUND: The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease.
METHODS: A total of 1205 patients were randomly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique. The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year. The costs of hospital resources used were also determined.
RESULTS: At one year, there was no significant difference between the two groups in terms of the rates of death, stroke, or myocardial infarction. Among patients who survived without a stroke or a myocardial infarction, 16.8 percent of those in the stenting group underwent a second revascularization, as compared with 3.5 percent of those in the surgery group. The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery (P<0.001 by the log-rank test). The costs for the initial procedure were $4,212 less for patients assigned to stenting than for those assigned to bypass surgery, but this difference was reduced during follow-up because of the increased need for repeated revascularization; after one year, the net difference in favor of stenting was estimated to be $2,973 per patient.
CONCLUSION: As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization.
Keywords
Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary/economics, Cerebrovascular Disorders/epidemiology, Cerebrovascular Disorders/prevention & control, Coronary Artery Bypass/economics, Coronary Disease/mortality, Coronary Disease/surgery, Cost-Benefit Analysis, Creatine Kinase/blood, Creatine Kinase, MB Form, Diabetes Complications, Disease-Free Survival, Female, Hospital Costs, Humans, Isoenzymes/blood, Male, Middle Aged, Myocardial Infarction/epidemiology, Myocardial Infarction/prevention & control, Quality of Life, Recurrence, Stents/economics, Treatment Outcome
Pubmed
Web of science
Create date
19/11/2007 12:16
Last modification date
20/08/2019 12:57
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