Coronary artery bypass surgery vs. percutaneous coronary intervention with stent implantation in patients with multivessel coronary disease (the Stent or Surgery Trial) - SoS

Description:

The goal of this study was to assess the safety and efficacy of stent-assisted percutaneous coronary intervention (PCI) compared to coronary artery bypass surgery (CABG) in the management of patients with multivessel disease.

Study Design

Study Design:

Mean Follow Up: 5 years
Female: 20

Patient Populations:

Stable or unstable angina pectoris symptoms; atherosclerotic CAD on coronary angiography with a significant lesion in at least two epicardial vessels. The lesions in question are likely to be flow limiting and merit consideration in a revascularization procedure.

Exclusions:

Previous CABG or other thoracotomy; previous coronary interventional procedure of any type (including PTCA and/or stenting); or intervention on the cardiac valves, myocardium, great vessels, carotids, or aorta scheduled for the index revascularization procedure

Drug/Procedures Used:

Patients with symptomatic multivessel coronary artery disease were randomized to CABG (n = 500) or stent-assisted PCI (n = 488) across 53 centers in Europe and Canada. Analysis of the primary (repeat revascularization) and secondary endpoints (death or Q-wave myocardial infarction or all-cause mortality) was by intention to treat.

Principal Findings:

The median duration of follow-up was 2 years (range 1-4 years). Patients undergoing PCI were more likely to require additional revascularization procedures at follow-up compared with the CABG group (21% vs. 6%, hazard ratio [HR] 3.85, 95% confidence interval [CI] 2.56-5.79, p

Interpretation:

Among patients with multivessel disease, PCI with coronary stent placement was associated with higher rates of death and repeat revascularization compared with CABG surgery through 5 years of follow-up.

References:

The SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet 2002;360:965-70.

Long-term follow-up data presented by Dr. John Pepper, European Society of Cardiology Scientific Congress, September 2006.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Coronary Angiography, Intention to Treat Analysis, Confidence Intervals, Coronary Artery Bypass, Stents, Percutaneous Coronary Intervention


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