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Selection of surgical or percutaneous coronary intervention provides differential longevity benefit.

Publication ,  Journal Article
Smith, PK; Califf, RM; Tuttle, RH; Shaw, LK; Lee, KL; Delong, ER; Lilly, RE; Sketch, MH; Peterson, ED; Jones, RH
Published in: Ann Thorac Surg
October 2006

BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG). METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting. RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD. CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2006

Volume

82

Issue

4

Start / End Page

1420 / 1428

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Risk Factors
  • Respiratory System
  • Prospective Studies
  • Male
  • Humans
  • Female
  • Coronary Stenosis
 

Citation

APA
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ICMJE
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Smith, P. K., Califf, R. M., Tuttle, R. H., Shaw, L. K., Lee, K. L., Delong, E. R., … Jones, R. H. (2006). Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg, 82(4), 1420–1428. https://doi.org/10.1016/j.athoracsur.2006.04.044
Smith, Peter K., Robert M. Califf, Robert H. Tuttle, Linda K. Shaw, Kerry L. Lee, Elizabeth R. Delong, R Eric Lilly, Michael H. Sketch, Eric D. Peterson, and Robert H. Jones. “Selection of surgical or percutaneous coronary intervention provides differential longevity benefit.Ann Thorac Surg 82, no. 4 (October 2006): 1420–28. https://doi.org/10.1016/j.athoracsur.2006.04.044.
Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006 Oct;82(4):1420–8.
Smith, Peter K., et al. “Selection of surgical or percutaneous coronary intervention provides differential longevity benefit.Ann Thorac Surg, vol. 82, no. 4, Oct. 2006, pp. 1420–28. Pubmed, doi:10.1016/j.athoracsur.2006.04.044.
Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006 Oct;82(4):1420–1428.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2006

Volume

82

Issue

4

Start / End Page

1420 / 1428

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Risk Factors
  • Respiratory System
  • Prospective Studies
  • Male
  • Humans
  • Female
  • Coronary Stenosis