Treatment of coronary artery disease(CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting(CABG). Patients with significant (75% stenosis) CAD at a single center between 1986 and 2000 underwent initial treatment strategies: medical therapy (MED(n 6862), PCI (n 6292), or CABG (n 5327).
Each group was categorized into 3 groups evaluated for all-cause adjusted mortality cardiac and comorbidity risks for selection of a specific treatment. :
- Low-severity (predominantly 1-vessel),
- Intermediate-severity (predominantly 2-vessel), and
- High-severity (all 3-vessel),
Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3:1996 to 2000), the last encompassing widespread availability of PCI with stenting.
Results:
Survival improved in all groups for all degrees of CAD, despite increasing severity of illness.
Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, inter-mediate-severity, and high-severity CAD, respectively.
Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p 0.039) in era 3 for CABG compared with PCI for high-severity CAD.
Conclusions:
Initial revascularization strategies resulted in a significant survival advantage over MED for all CAD levels.
Patients with high-severity CAD treated in each period with CABG vs. PCI had an additional survival benefit :
From: Division of Thoracic Surgery, Department of Surgery, Division of Cardiology, Department of Medicine, Duke University MedicalCenter, and Duke Clinical Research Institute, Durham, North Carolina (Ann Thorac Surg 2006;82:1420–9)© 2006 by The Society of Thoracic Surgeons)