A prospective study by Serruys and colleagues was conducted between March 2005 and April 2007 at sites in the United States and Europe to determine whether coronary artery bypass grafting (CABG)-the standard of care-or percutaneous coronary intervention (PCI) was superior in treating patients with three-vessel or left main coronary artery disease. Patients were randomized to receive either CABG or PCI if the procedures were equally likely to result in successful revascularization.

Of the 1,800 patients randomized, 897 received CABG and 903 received PCI with drug-eluting stents. The two groups had similar demographics and baseline disease characteristics. The average number of coronary lesions treated was also similar between groups (a mean of 4.4 in the CABG group versus 4.3 in the PCI group).

During the 12-month follow-up period, more patients in the PCI group (17.8%) than in the CABG group (12.4%) experienced a major cardiac or cerebrovascular event, and a higher percentage of PCI patients (13.5%) than CABG patients (5.9%) required repeat revascularization. Death rates were similar between groups (4.4% in the PCI group versus 3.5% in the CABG group). However, the stroke rate was higher in the CABG group (2.2%) than in the PCI group (0.6%).

Patients with left main coronary artery disease in the PCI and CABG groups had a similar rate of major cardiovascular events (15.8% and 13.7%, respectively). However, in those with three-vessel disease alone, the cardiovascular event rate was higher in the PCI (19.2%) than in the CABG group (11.5%).

The authors concluded that CABG resulted in fewer major cardiac or cerebrovascular events and should remain the standard intervention therapy for patients with coronary artery disease.

JC