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


Sigwart, U; Stables, RH; Booth, J; Erbel, R; Wahrborg, P; Lubsen, J; Nihoyannopoulos, P; Pepper, J; King, SB; Weintraub, W; Sleight, P; Clayton, T; Pocock, S; Nugara, F; Rickards, A; Chronos, N; Flather, MD; Thompson, S; Dooley, P; Collinson, J; Stuteville, M; Delahunty, N; Wright, A; Forster, M; Ludman, P; de Souza, A; Ischinger, T; Buszman, P; Martuscelli, E; Davies, S; Goy, JJ; Olivari, Z; Shibata, M; Bakhai, A; Perez, D; Kotsiva, K; Kamdar, R; Koutroulis, G; Ritsou, M; Balcon, R; Sergeant, P; Perry, RA; Illsley, C; Simpson, I; Norell, MS; Grip, L; Heikkila, J; Macaya, C; Brecker, S; Angel, J; Legrand, V; Thomas, M; Roberts, DH; Bernardi, G; Wijns, W; Bilodeau, L; Buller, CE; Nordrehaug, JE; da Cunha, JAC; Schuler, G; Marquis, JF; Waas, W; Pfisterer, M; Mudra, H; Klauss, V; Niemela, K; Meier, B; Endresen, K; Simon, R; Eckhout, E; Manari, A; Ormerod, O; Corr, L; Gomes, S; Cequier, A; Knudtson, ML; Kokott, N; Golf, S; Meloni, GF; Chierchia, S; Groves, P; Vassanelli, C; Valdes, M; Luderitz, B; Cumberland, D; Olsson, H; Vrints, C; (2002) 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, 360 (9338). pp. 965-70. ISSN 0140-6736 DOI: https://doi.org/10.1016/S0140-6736(02)11078-6

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Abstract

BACKGROUND: Results of trials, comparing percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass grafting (CABG), indicate that rates of death or myocardial infarction are similar with either treatment strategy. Management with PTCA is, however, associated with an increased requirement for subsequent, additional revascularisation. Coronary stents, used as an adjunct to PTCA, reduce restenosis and the need for repeat revascularisation. The aim of the Stent or Surgery (SoS) trial was to assess the effect of stent-assisted percutaneous coronary intervention (PCI) versus CABG in the management of patients with multivessel disease. METHODS: In 53 centres in Europe and Canada, symptomatic patients with multivessel coronary artery disease were randomised to CABG (n=500) or stent-assisted PCI (n=488). The primary outcome measure was a comparison of the rates of repeat revascularisation. Secondary outcomes included death or Q-wave myocardial infarction and all-cause mortality. Analysis was by intention to treat. FINDINGS: All patients were followed-up for a minimum of 1 year and the results are expressed for the median follow-up of 2 years. 21% (n=101) of patients in the PCI group required additional revascularisation procedures compared with 6% (n=30) in the CABG group (hazard ratio 3.85, 95% CI 2.56-5.79, p<0.0001). The incidence of death or Q-wave myocardial infarction was similar in both groups (PCI 9% [n=46], CABG 10% [n=49]; hazard ratio 0.95, 95% CI 0.63-1.42, p=0.80). There were fewer deaths in the CABG group than in the PCI group (PCI 5% [n=22], CABG 2% [n=8]; hazard ratio 2.91, 95% CI 1.29-6.53, p=0.01). INTERPRETATION: The use of coronary stents has reduced the need for repeat revascularisation when compared with previous studies that used balloon angioplasty, though the rate remains significantly higher than in patients managed with CABG. The apparent reduction in mortality with CABG requires further investigation.

Item Type: Article
Keywords: Angioplasty, Transluminal, Percutaneous Coronary/*methods/mortality, Comparative Study, *Coronary Artery Bypass/mortality, Coronary Disease/mortality/*therapy, Female, Follow-Up Studies, Human, Male, Middle Age, Recurrence, *Stents, Support, Non-U.S. Gov't, Treatment Outcome, Angioplasty, Transluminal, Percutaneous Coronary, methods, mortality, Comparative Study, Coronary Artery Bypass, mortality, Coronary Disease, mortality, therapy, Female, Follow-Up Studies, Human, Male, Middle Age, Recurrence, Stents, Support, Non-U.S. Gov't, Treatment Outcome
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 12383664
Web of Science ID: 178249000007
URI: http://researchonline.lshtm.ac.uk/id/eprint/15756

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