Back to Search
Start Over
Comparative effectiveness of revascularization strategies.
- Source :
-
The New England journal of medicine [N Engl J Med] 2012 Apr 19; Vol. 366 (16), pp. 1467-76. Date of Electronic Publication: 2012 Mar 27. - Publication Year :
- 2012
-
Abstract
- Background: Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG.<br />Methods: We linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias.<br />Results: Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group; risk ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%; risk ratio, 0.79; 95% CI, 0.76 to 0.82). Similar results were noted in multiple subgroups and with the use of several different analytic methods. Residual confounding was assessed by means of a sensitivity analysis.<br />Conclusions: In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI. (Funded by the National Heart, Lung, and Blood Institute.).
- Subjects :
- Aged
Comparative Effectiveness Research
Confounding Factors, Epidemiologic
Coronary Disease mortality
Coronary Disease surgery
Databases, Factual
Female
Follow-Up Studies
Humans
Male
Observation
Proportional Hazards Models
Survival Analysis
United States
Angioplasty, Balloon, Coronary
Coronary Artery Bypass
Coronary Disease therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 366
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 22452338
- Full Text :
- https://doi.org/10.1056/NEJMoa1110717