By Sahar Bedrood B.S. and Asher Kimchi M.D.

Albany, NY - Coronary-Artery Bypass Grafting (CABG) and percutaneous coronary intervention (PCI) have been the predominant therapeutic procedures for coronary artery occlusion. Though stenting procedures have made great advancements over the last few years, there have been no recent studies comparing the outcomes of stenting and CABG for patients with advanced coronary artery disease. Edward Hannan M.D. et al from the University at Albany, State University of New York used observational data from a large registry to compare short-term and long-term outcomes among patients with multi-vessel disease who underwent CABG or stenting. The study was published in the May 26, 2005 issue of The New England Journal of Medicine and found that for patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting.

The study identified 37,212 patients with multi-vessel disease who underwent CABG and 22,102 patients with multi-vessel disease who underwent PCI from January 1, 1997, to December 31, 2000. The rate of death and subsequent revascularization within three years after the procedure was determined. End points included death and death or revascularization (CABG or PCI) at any time before December 31, 2000.

Survival rates were significantly higher for the patients who underwent CABG than those who received a stent. The adjusted hazard ratio for the long-term risk of death after CABG relative to stent implantation was 0.64 (95 percent confidence interval, 0.56 to 0.74) for patients with three-vessel disease with involvement of the proximal left anterior descending coronary artery and 0.76 (95 percent confidence interval, 0.60 to 0.96) for patients with two-vessel disease with involvement of the nonproximal left anterior descending coronary artery. Also, the three-year rates of revascularization were considerably higher in the stenting group than in the CABG group (7.8 percent vs. 0.3 percent for subsequent CABG and 27.3 percent vs. 4.6 percent for subsequent PCI).

There are many considerations a physician and patient need to account for before determining the appropriate treatment. While stenting is less invasive and associated with lower in-hospital mortality at the time of the procedure, CABG has a higher rate of long-term survival.  

Coauthors: Hannan, Edward L.; Racz, Michael J.; Walford, Gary; Jones, Robert H.; Ryan, Thomas J.; Bennett, Edward; Culliford, Alfred T.; Isom, O. Wayne; Gold, Jeffrey P.; Rose, Eric A.