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

3 Citations (Scopus)

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
Pages (from-to)432-437
Number of pages6
JournalJournal of Cardiology
Volume73
Issue number5
DOIs
Publication statusPublished - 2019 May

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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