NEJM Volume 358:331-341  January 24, 2008  Number 4

Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel
Coronary Disease

Edward L. Hannan, Ph.D., Chuntao Wu, M.D., Ph.D., Gary Walford, M.D.,
Alfred T. Culliford, M.D., Jeffrey P. Gold, M.D., Craig R. Smith,
M.D., Robert S.D. Higgins, M.D., Russell E. Carlson, M.D., and Robert
H. Jones, M.D.

ABSTRACT

Background Numerous studies have compared the outcomes of two
competing interventions for multivessel coronary artery disease:
coronary-artery bypass grafting (CABG) and coronary stenting. However,
little information has become available since the introduction of drug-
eluting stents.

Methods We identified 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 we compared adverse
outcomes (death, death or myocardial infarction, or repeat
revascularization) through December 31, 2005, after adjustment for
differences in baseline risk factors among the patients.

Results In comparison with treatment with a drug-eluting stent, CABG
was associated with lower 18-month rates of death and of death or
myocardial infarction both for patients with three-vessel disease and
for patients with two-vessel disease. Among patients with three-vessel
disease who underwent CABG, as compared with those who received a
stent, the adjusted hazard ratio for death was 0.80 (95% confidence
interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0%
versus 92.7% (P=0.03); the adjusted hazard ratio for death or
myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted
rate of survival free from myocardial infarction was 92.1% versus
89.7% (P<0.001). Among patients with two-vessel disease who underwent
CABG, as compared with those who received a stent, the adjusted hazard
ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted
survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard
ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to
0.87) and the adjusted rate of survival free from myocardial
infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG
also had lower rates of repeat revascularization.

Conclusions For patients with multivessel disease, CABG continues to
be associated with lower mortality rates than does treatment with drug-
eluting stents and is also associated with lower rates of death or
myocardial infarction and repeat revascularization.

Source Information

From the University at Albany, Albany, NY (E.L.H., C.W.); St. Joseph's
Hospital, Syracuse, NY (G.W.); New York University Medical Center, New
York (A.T.C.); Medical University of Ohio, Toledo (J.P.G.); Columbia-
Presbyterian Medical Center, New York (C.R.S.); Rush University
Medical Center, Chicago (R.S.D.H.); Mercy Hospital, Buffalo, NY
(R.E.C.); and Duke University Medical Center, Durham, NC (R.H.J.).

Address reprint requests to Dr. Hannan at the Department of Health
Policy, Management, and Behavior, School of Public Health, State
University of New York, University at Albany, 1 University Pl.,
Rensselaer, NY 12144-3456, or at elh03@health.state.ny.us.