The technology of drug eluting stents for percutaneous coronary intervention (PCI) has improved over time with resultant improvements in patient outcomes.\u00a0 Although prior studies have demonstrated the benefit of surgical coronary artery bypass grafting (CABG) over transcatheter PCI among patients with multivessel coronary artery disease (CAD), these studies did not incorporate newer generation drug-eluting stents.\u00a0 The multicenter BEST trial randomized 880 patients with multivessel CAD to PCI with an everolimus-eluting stent or to CABG. The primary end point for this non-inferiority study was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years.\u00a0 The results of the study non-significantly favored CABG at 2 years of follow-up with the primary end-point occurring in 7.9% of the CABG group and 11% of the PCI group.\u00a0 This advantage achieved statistical significance in longer term follow-up (median 4.6 years, 10.6% vs. 15.3%, HR, 1.47; 95% CI, 1.01 to 2.13; P=0.04).\u00a0 The majority of this benefit was driven by a higher rate of repeat revascularization among patients treated with PCI; there were no significant differences in the rates of death, overall myocardial infarction or stroke between CABG and PCI.<\/p>\n
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Conclusions: <\/strong>In this large randomized trial of patients with multi-vessel coronary disease, CABG continued to demonstrate lower rates of adverse events in comparison to patients treated with modern generation drug-eluting stents.\u00a0 This difference in outcomes was driven by higher rates of repeat revascularization with PCI and not by differences in the rates of myocardial infarction, stroke or death.<\/p>\n <\/p>\n Summarized by Hussain Contractor and Steven M. Bradley<\/p>\n <\/p>\n