Second-generation drug-eluting stenting versus coronary artery bypass grafting for treatment of coronary chronic total occlusion

Woo Jin Jang, Jeong Hoon Yang, Young Bin Song, Joo Yong Hahn, Woo Jung Chun, Ju Hyeon Oh, Wook Sung Kim, Young Tak Lee, Cheol Woong Yu, Hyun Jong Lee, Hyeon Cheol Gwon, Seung Hyuk Choi

Research output: Contribution to journalArticle

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Abstract

Background: Limited data are available regarding the long-term clinical outcomes of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD) with chronic total occlusion (CTO). We compared the clinical outcomes of patients with multivessel CAD including CTO lesions treated with PCI using DESs versus CABG. Methods: We analyzed data from 423 consecutive patients who underwent successful revascularization for CTO between March 2008 and February 2012. Death or myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) were compared between patients treated with PCI using second-generation DESs (n = 232, 2nd DES group) versus those treated with CABG (n = 191, CABG group). To reduce selection bias according to treatment strategy and other potential confounding factors, inverse probability of treatment weighting (IPTW) was also performed. Results: During a median follow-up duration of 32 months, there was no significant difference in death or MI [hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.29–1.63; p = 0.399] or MACCE (HR: 1.32; 95% CI: 0.74–2.35; p = 0.341) between the 2nd DES group and the CABG group based on multivariable analysis. After IPTW adjustment, the incidences of death or MI (HR: 0.72; 95% CI: 0.26–1.95; p = 0.518) and MACCE (HR: 1.49; 95% CI: 0.76–2.91; p = 0.244) remained similar in the two groups. In subgroup analysis, the effect of second-generation drug-eluting stenting was comparable to that of CABG across various subgroups without a significant p-value for the interaction. Conclusions: The efficacy of PCI using second-generation DES was comparable to that of CABG in CTO patients with multivessel CAD.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Drug-Eluting Stents
Coronary Artery Bypass
Percutaneous Coronary Intervention
Pharmaceutical Preparations
Confidence Intervals
Coronary Artery Disease
Myocardial Infarction
Therapeutics
Cohort Effect
Selection Bias
Incidence

Keywords

  • Chronic total occlusion
  • Coronary artery bypass grafting
  • Percutaneous coronary intervention
  • Second-generation drug-eluting stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Second-generation drug-eluting stenting versus coronary artery bypass grafting for treatment of coronary chronic total occlusion. / Jang, Woo Jin; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo Yong; Chun, Woo Jung; Oh, Ju Hyeon; Kim, Wook Sung; Lee, Young Tak; Yu, Cheol Woong; Lee, Hyun Jong; Gwon, Hyeon Cheol; Choi, Seung Hyuk.

In: Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Jang, Woo Jin ; Yang, Jeong Hoon ; Song, Young Bin ; Hahn, Joo Yong ; Chun, Woo Jung ; Oh, Ju Hyeon ; Kim, Wook Sung ; Lee, Young Tak ; Yu, Cheol Woong ; Lee, Hyun Jong ; Gwon, Hyeon Cheol ; Choi, Seung Hyuk. / Second-generation drug-eluting stenting versus coronary artery bypass grafting for treatment of coronary chronic total occlusion. In: Journal of Cardiology. 2019.
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AU - Jang, Woo Jin

AU - Yang, Jeong Hoon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Chun, Woo Jung

AU - Oh, Ju Hyeon

AU - Kim, Wook Sung

AU - Lee, Young Tak

AU - Yu, Cheol Woong

AU - Lee, Hyun Jong

AU - Gwon, Hyeon Cheol

AU - Choi, Seung Hyuk

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N2 - Background: Limited data are available regarding the long-term clinical outcomes of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD) with chronic total occlusion (CTO). We compared the clinical outcomes of patients with multivessel CAD including CTO lesions treated with PCI using DESs versus CABG. Methods: We analyzed data from 423 consecutive patients who underwent successful revascularization for CTO between March 2008 and February 2012. Death or myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) were compared between patients treated with PCI using second-generation DESs (n = 232, 2nd DES group) versus those treated with CABG (n = 191, CABG group). To reduce selection bias according to treatment strategy and other potential confounding factors, inverse probability of treatment weighting (IPTW) was also performed. Results: During a median follow-up duration of 32 months, there was no significant difference in death or MI [hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.29–1.63; p = 0.399] or MACCE (HR: 1.32; 95% CI: 0.74–2.35; p = 0.341) between the 2nd DES group and the CABG group based on multivariable analysis. After IPTW adjustment, the incidences of death or MI (HR: 0.72; 95% CI: 0.26–1.95; p = 0.518) and MACCE (HR: 1.49; 95% CI: 0.76–2.91; p = 0.244) remained similar in the two groups. In subgroup analysis, the effect of second-generation drug-eluting stenting was comparable to that of CABG across various subgroups without a significant p-value for the interaction. Conclusions: The efficacy of PCI using second-generation DES was comparable to that of CABG in CTO patients with multivessel CAD.

AB - Background: Limited data are available regarding the long-term clinical outcomes of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD) with chronic total occlusion (CTO). We compared the clinical outcomes of patients with multivessel CAD including CTO lesions treated with PCI using DESs versus CABG. Methods: We analyzed data from 423 consecutive patients who underwent successful revascularization for CTO between March 2008 and February 2012. Death or myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) were compared between patients treated with PCI using second-generation DESs (n = 232, 2nd DES group) versus those treated with CABG (n = 191, CABG group). To reduce selection bias according to treatment strategy and other potential confounding factors, inverse probability of treatment weighting (IPTW) was also performed. Results: During a median follow-up duration of 32 months, there was no significant difference in death or MI [hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.29–1.63; p = 0.399] or MACCE (HR: 1.32; 95% CI: 0.74–2.35; p = 0.341) between the 2nd DES group and the CABG group based on multivariable analysis. After IPTW adjustment, the incidences of death or MI (HR: 0.72; 95% CI: 0.26–1.95; p = 0.518) and MACCE (HR: 1.49; 95% CI: 0.76–2.91; p = 0.244) remained similar in the two groups. In subgroup analysis, the effect of second-generation drug-eluting stenting was comparable to that of CABG across various subgroups without a significant p-value for the interaction. Conclusions: The efficacy of PCI using second-generation DES was comparable to that of CABG in CTO patients with multivessel CAD.

KW - Chronic total occlusion

KW - Coronary artery bypass grafting

KW - Percutaneous coronary intervention

KW - Second-generation drug-eluting stent

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