Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

Spertus, John A.; Nerella, Ravi; Kettlekamp, Richard; House, John A.; Marso, Steven P.; Borkon, A. Michael; Rumsfeld, John S.

doi:10.1161/01.cir.0000155242.70417.60

Cited by 51 publications

(34 citation statements)

References 35 publications

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“…4 Predictive restenosis risk stratification models might be helpful for identifying patients who may preferentially benefit from surgery compared with stenting. 9,10 This is of particular importance because only a minority of patients without apparent in-stent restenosis at 6-month follow-up will require subsequent target vessel revascularization. 11 The indication for repeated revascularization procedures was clinically and not angiographically driven.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

et al. 2005

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Background-Randomized trials comparing stenting with minimally invasive direct coronary artery bypass surgery in patients with isolated proximal left anterior descending lesions have shown a significantly higher reintervention rate for stenting and similar results for mortality and reinfarction at short-term follow-up. Long-term follow-up data are sparse. Methods and Results-Patients with isolated proximal left anterior descending stenosis were randomized to either surgery (nϭ110) or bare-metal stenting (nϭ110). At 5 years, follow-up data were obtained with respect to the primary end point of death, reinfarction, or repeated target vessel revascularization. Clinical symptoms were assessed by the Canadian Cardiovascular Society (CCS) classification. Follow-up information was completed for 216 patients (98.2%), and mean follow-up was 5.6Ϯ1.2 years. With respect to mortality (surgery, 12%; stenting, 10%; Pϭ0.54) and reinfarctions (surgery, 7%; stenting, 5%; Pϭ0.46), there were no differences between treatment strategies. The need for repeated target vessel revascularization was significantly higher after stenting (32%) compared with surgery (10%; PϽ0.001).Clinical symptoms improved significantly in both treatment groups compared with baseline; however, there was a favorable trend for surgery (stenting: CCS, 2.6Ϯ0.9 to 0.5Ϯ0.8, PϽ0.001; surgery: CCS, 2.6Ϯ0.9 to 0.3Ϯ0.6, PϽ0.001; Pϭ0.05, stenting versus surgery). Conclusions-At the 5-year follow-up, minimally invasive bypass surgery and bare-metal stenting showed similar results for the end points of mortality and reinfarctions. However, the reintervention rate is higher after stenting, and the relief in clinical symptoms is slightly better after surgery. (Circulation. 2005;112:3445-3450.)

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Section: Discussionmentioning

confidence: 99%

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

et al. 2005

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“…8 -10 However, several key predictors-younger patient age, performance of unprotected left main PCI, and SVG location-have not been reported consistently in prior models. One single-center analysis of bare metal stents by Spertus et al 8 identified age Ͻ55 years as a predictor of restenosis, but several more recent DES studies have not reported this finding. 10,11 Left main PCI was much less likely to be undertaken before widespread acceptance of DES and therefore was unlikely to have been adequately represented in prior observational registries to be identified as a TLR risk factor.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…To better identify patients at higher risk of restenosis, several investigators have developed risk-prediction models based on clinical and angiographic variables associated with target lesion revascularization (TLR). However, these models were developed before widespread availability of DES, 8,9 in singlecenter experiences, 10,11 or in restrictive patient subsets. 4 In addition, none of the predictors identified in DES populations have undergone independent validation.…”

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confidence: 99%

Predicting Restenosis of Drug-Eluting Stents Placed in Real-World Clinical Practice

Stolker

Kennedy

Lindsey

et al. 2010

Circ: Cardiovascular Interventions

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on behalf of the EVENT InvestigatorsBackground-Prediction of restenosis after percutaneous coronary intervention (PCI) remains challenging, and existing risk assessment algorithms were developed before the widespread adoption of drug-eluting stents (DES). Methods and Results-We used data from the EVENT registry to develop a risk model for predicting target lesion revascularization (TLR) in 8829 unselected patients undergoing DES implantation between 2004 and 2007. Using a split-sample validation technique, predictors of TLR at 1 year were identified from two thirds of the subjects (derivation cohort) using multiple logistic regression. Integer point values were created for each predictor, and the summed risk score (range, 0 to 10) was applied to the remaining sample (validation cohort). At 1 year, TLR occurred in 4.2% of patients, and after excluding stent thrombosis and early mechanical complications, the incidence of late TLR (more likely representing restenosis-related TLR) was 3.6%. Predictors of TLR were age Ͻ60, prior PCI, unprotected left main PCI, saphenous vein graft PCI, minimum stent diameter Յ2.5 mm, and total stent length Ն40 mm. Comparison of observed versus predicted rates of TLR according to risk score demonstrated good model fit in the validation set. There was more than a 3-fold difference in TLR rates between the lowest risk category (scoreϭ0; TLR rate, 2.2%) and the highest risk category (score Ն5; TLR rate, 7.5%). Conclusions-The overall incidence of TLR remains low among unselected patients receiving DES in routine clinical practice. A simple risk model incorporating 6 readily available clinical and angiographic variables helps identify individuals at extremely low (Ͻ2%) and modestly increased (Ͼ7%) risk of TLR after DES implantation. (Circ Cardiovasc Interv. 2010;3:327-334.)

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“…Moreover, a systematic evaluation of the psychological burden of undergoing multiple stent procedures over time is lacking, and only limited information exists about the quality of life of these patients. 18 Finally, the cost-effectiveness of multiple PCI procedures compared with CABG has to be questioned.…”

Section: Limitationsmentioning

confidence: 99%

Prognostic Significance of Multiple Previous Percutaneous Coronary Interventions in Patients Undergoing Elective Coronary Artery Bypass Surgery

et al. 2006

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Background— A possible relationship between increased perioperative risk during coronary artery bypass grafting (CABG) and previous percutaneous coronary intervention (PCI) is debatable. We sought to determine the impact of previous PCI on patient outcome after elective CABG. Methods and Results— Between January 2000 and January 2005, 2626 consecutive patients undergoing first-time isolated elective CABG as the primary revascularization procedure (group 1) were evaluated for in-hospital mortality and major adverse cardiac events (MACEs) and were compared with 360 patients after single PCI (group 2) and with 289 patients after multiple PCI sessions (group 3) before elective CABG. Unadjusted univariate and risk-adjusted multivariate logistic-regression analysis revealed previous multiple PCIs to be strongly associated with in-hospital mortality (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.52 to 3.21; P <0.001) and MACEs (OR, 2.28; 95% CI, 1.38 to 3.59; P <0.001). To control for selection bias, a computed propensity-score matching based on 13 patient characteristics and preoperative risk factors was performed separately comparing group 1 versus 2 and group 1 versus 3. After propensity matching, conditional logistic-regression analysis confirmed previous multiple PCIs to be strongly associated with in-hospital mortality (OR, 3.01; 95% CI, 1.51 to 5.98; P <0.0017) and MACEs (OR, 2.31; 95% CI, 1.45 to 3.67; P <0.0004). Conclusions— In patients with a history of multiple PCI sessions, perioperative risk for in-hospital mortality and MACEs during subsequent elective CABG is increased.

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Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

Abstract: Background-Previous

Cited by 51 publications

References 35 publications

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Predicting Restenosis of Drug-Eluting Stents Placed in Real-World Clinical Practice

Prognostic Significance of Multiple Previous Percutaneous Coronary Interventions in Patients Undergoing Elective Coronary Artery Bypass Surgery

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