Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial

Abstract

Background: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stent and coronary-artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. Methods: This prospective, multicenter, randomized, controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stent or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early due to slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target-vessel revascularization. Results: During a median follow-up of 11.8 years (interquartile range, 10.6 to 12.5 years, maximum 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR] 1.18; 95% confidence interval [CI], 0.88 to 1.56; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%, HR 1.07; 95% CI 0.75 to 1.53; P=0.70) as well as the occurrence of death from any cause (20.5% and 19.9%, HR 1.04; 95% CI 0.65 to 1.67; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%, HR 1.86; 95% CI 1.06 to 3.27; P=0.031) and any repeat revascularization (22.6% and 12.7%, HR 1.92; 95% CI 1.58 to 2.32; P<0.001) were more frequent after PCI than after CABG. Conclusions: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, safety composite end point, and all-cause mortality during extended-follow-up.

Surgical and percutaneous coronary revascularization in patients with multivessel or left main disease; what happens beyond five years? A systematic review and study level meta-analysis of randomized trials

“…The literature search identified 475 records and 13 studies were considered relevant and then retrieved. Among them, 4 RCTs [BEST (NCT05125367 and NCT00997828) FREEDOM (NCT00086450), PRECOMBAT (NCT03871127 and NCT00422968) and SYNTAX (NCT03417050) (20)(21)(22)(23)] met the eligibility criteria and were included in the final analysis. The PRISMA Flow Chart of study selection is shown in Supplemental Figure 1.…”

Five-year outcomes of double kissing mini-culotte stenting vs. mini-culotte stenting using drug-eluting stents for the treatment of true coronary bifurcation lesions

“…The protocol was approved by the Medical Ethics Committee of Union Hospital, Fujian Medical University. The identity of patients remained anonymous, and the requirement for informed consent was waived due to the observational nature of the study ( 14 , 15 ).…”

“…The protocol was approved by the Medical Ethics Committee of Union Hospital, Fujian Medical University. The identity of patients remained anonymous, and the requirement for informed consent was waived due to the observational nature of the study (14,15). PCI was determined by an experienced heart team (interventional cardiologists) based on clinical risk, angiographic characteristics, and patients' preferences.…”

Der koronarkranke Diabetiker: moderne Therapieansätze und Behandlungspfade

“…In der BEST-Studie wurden Patienten mit Mehrgefäß-KHK zu entweder PCI mittels DES einer neueren Generation (Everolimuseluting Stent) oder CABG randomisiert; in der Subgruppe derjenigen 363 Patienten mit Diabetes mellitus wurde der primäre Endpunkt (Tod, Myokardinfarkt oder Target-Vessel-Revaskularisation nach 2 Jahren) signifikant häufiger nach PCI erreicht [26]; die Daten der verlängerten Beobachtungsdauer (im Mittel 11,8 Jahre) von BEST zeigten zudem bezüglich der Endpunkte Myokardinfarkt und erneute Revaskularisation ein signifikant besseres Abschneiden der CABG gegenüber der PCI [27].…”