Coronary artery revascularization evaluation--a multicenter registry with seven years of follow-up.

Data from randomized clinical trials comparing coronary artery bypass grafting (cabg) and percutaneous coronary intervention (pci) may not accurately reflect current clinical practice,in which there is off-label usage of drug-eluting stents (des). we undertook a prospective registry of coronary revascularization by cabg on- and off-pump and pci with bare-metal stents (bmss),dess,or percutaneous transluminal coronary angioplasty (ptca) to determine clinical outcomes. all patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. final follow-up was obtained after 5 years by patient and/or physician contact and the social security death index. st-elevation myocardial infarction and salvage patients were excluded. five or more years of follow-up was obtained on 81.5% (3156) of the eligible patients-968 cabg patients (82.0%) and 2188 pci patients (81.3%). overall follow-up was 63.5±27.9 months (median,79.7 months). the incidence of initial major adverse cardiac events (maces) at follow-up for cabg versus pci was 29.2% versus 41.8% (p<0.001). analysis of stent subgroups showed more events with bmss (equivalent to ptca alone) compared with dess. all stents had more events than on- or off-pump cabg groups. using propensity score-matched groups,the odds ratio for cabg to pci was 0.69 (95% confidence interval [ci],0.56 to 0.85; p<0.001) for mortality and 0.58 (95% ci,0.45 to 0.75; p<0.001) for any mace. in the current era of des and off-pump surgery,in a community hospital setting,comparable patients undergoing coronary revascularization appear to benefit from improved long-term survival and reduced mace with cabg versus pci.