BEST: CABG Superior to PCI with Second-Gen Drug-Eluting Stents in CAD Patients

Patients with multi-vessel coronary artery disease (CAD) have a lower risk of cardiovascular events after coronary-artery bypass grafting (CABG) than after coronary intervention (PCI) plus second generation drug-eluting stent, according to research presented as part of ACC.15 in San Diego, CA on Monday, March 16 and simultaneously published in the New England Journal of Medicine.

Lead author Seung-Jung Park, MD, PhD, FACC along with co-authors, conducted the BEST clinical trial using a 1:1 non-inferiority trial across 27 centers in East Asia and included a total of 880 multi-vessel CAD patients. Patients were randomly divided into two groups and were assigned to PCI with everolimus-eluting stents or to CABG. The study recorded composite mortality, myocardial infarction (MI) or target-vessel revascularization after two years.

Major cardiovascular events or mortality occurred in 11.0 percent of PCI patients versus just 7.9 percent of patients in the CABG group after two years. The study followed up with patients again after an average of 4.6 years and discovered negative outcomes in 15.3 percent of PCI patients versus 10.6 percent in CABG patients. Furthermore, risk of additional revascularizations and MI were significantly higher after PCI versus CABG.

Ultimately, authors found that CABG was a safer and more effective course of action for CAD patients even after the addition of new drug-eluting stents to PCI.

In a separate study published in the New England Journal of Medicine, author Sripal Bangalore, MBBS, MHA, FACC, et al, conducted a contemporary, clinical-practice registry study and found that the risk of death in PCI with everolimus-eluting stents was comparable to CABG. Patients who had undergone PCI had an elevated risk of MI or repeat revascularization but a lower risk of stroke as compared to CABG patients.

The study suggested that future investigations could include analysis of additional clinical practice registries such as the ACC’s CathPCI Registry which assesses the characteristics, treatments and outcomes of cardiac disease patients who receive diagnostic catheterization and/or PCI procedures and measures the adherence to guidelines, performance standards and appropriate use criteria.

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

Keywords: Arteries, Asia, Catheterization, Coronary Artery Bypass, Coronary Artery Disease, Coronary Disease, Drug-Eluting Stents, Far East, Humans, India, Myocardial Infarction, Registries, Sirolimus, Stroke, Cardiovascular Meetings, National Cardiovascular Data Registries, CathPCI Registry, ACC Annual Scientific Session

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