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Coronary Artery Bypass Grafting Best for Certain Patients

Percutaneous coronary intervention not beneficial in patients with certain coronary artery diseases

WEDNESDAY, Feb. 18 (HealthDay News) -- Coronary artery bypass grafting (CABG), and not percutaneous coronary intervention (PCI), results in lower incidence of cardiac or cerebrovascular events in patients with three-vessel or left main coronary artery disease, and should therefore remain the standard of care, according to research released online Feb. 18 in advance of publication in the Mar. 5 issue of the New England Journal of Medicine.

Patrick W. Serruys, M.D., Ph.D., of Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues performed a randomized study in which 1,800 patients with three-vessel or left main coronary artery disease underwent CABG or PCI. Patients were followed-up for 12 months after the intervention.

Over the study period, patients who underwent PCI experienced a significantly higher incidence of major cardiac or cerebrovascular events compared with patients who received CABG (17.8 percent versus 12.4 percent), the investigators found. This was largely due to an increase in the proportion of patients who experienced a repeat revascularization (13.5 percent in the PCI group versus 5.9 percent in the CABG group). The mortality rate was not significantly different between the two groups, but CABG patients experienced a higher incidence of stroke, the researchers report.

"The results of our trial show that CABG, as compared with PCI, is associated with a lower rate of major adverse cardiac or cerebrovascular events at one year among patients with three-vessel or left main coronary artery disease (or both) and should therefore remain the standard of care for such patients," the authors conclude.

The study supported by Boston Scientific and several of the study authors report financial relationships with the pharmaceutical industry.

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