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Everolimus-eluting stents or bypass surgery for left main coronary artery disease
- Source :
- New England Journal of Medicine, 375(23), 2223-2235. Massachussetts Medical Society
- Publication Year :
- 2017
- Publisher :
- Massachusetts Medical Society, 2017.
-
Abstract
- BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Coronary Artery Disease
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
law.invention
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Randomized controlled trial
law
Internal medicine
medicine
Clinical endpoint
Drug-Eluting Stent
Humans
Everolimus
030212 general & internal medicine
cardiovascular diseases
Coronary Artery Bypass
Aged
Female
Middle Aged
Drug-Eluting Stents
business.industry
Coronary Artery Bypa
Medicine (all)
Percutaneous coronary intervention
General Medicine
medicine.disease
Surgery
Cardiac surgery
Everolimu
surgical procedures, operative
Bypass surgery
Conventional PCI
Cardiology
business
medicine.drug
Human
Subjects
Details
- Language :
- English
- ISSN :
- 00284793
- Database :
- OpenAIRE
- Journal :
- New England Journal of Medicine, 375(23), 2223-2235. Massachussetts Medical Society
- Accession number :
- edsair.doi.dedup.....0632d986012b303f06de9f7640cfd98c