Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Disease

The authors of this article compared CABG and PCI with second generation drug eluting stents (DES-PCI) in patients with multivessel coronary artery disease. They used data from a large observational registry and applied propensity score matching to create groups with similar baseline characteristics. They found that, at a mean follow-up of almost 3 years, DES-PCI and CABG had a similar risk of all-cause death (3.1% per year versus 2.9% per year, p=0.50), but a higher risk of myocardial infarction (1.9% per year vs. 1.1% per year; p<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year, p<0.001). The risk of stroke was lower with DES-PCI (0.7% per year vs. 1.0% per year, p<0.001). The higher risk of myocardial infarction seemed to be restricted to those DES-PCI patients in whom there was incomplete revascularization.  The authors conclude that the 3-year mortality risk between second generation DES-PCI and CABG was similar. DES-PCI was associatied with higher risk of myocadial infarction and repeat revascularization, but had a lower risk of stroke.