Trial of Everolimus-Eluting Stents or Bypass Surgery for Coronary Disease

Park, Seung Jung; Ahn, Jung Min; Kim, Young Hak; Park, Duk‐Woo; Yun, Sung Cheol; Lee, Jong‐Young; Kang, Soo Jin; Lee, Seung Whan; Lee, Cheol Whan; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Cohen, David J.; Yeung, Alan C.; Hur, Seung Ho; Seung, Ki Bae; Ahn, Tae Hoon; Kwon, Hyuck Moon; Lim, Do Sun; Rha, Seung Woon; Jeong, Myung Ho; Lee, Bong Ki; Tresukosol, Damras; Guo, Fu; Ong, Tiong Kiam

doi:10.1056/nejmoa1415447

Cited by 423 publications

(315 citation statements)

References 26 publications

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“…None of the following studies comparing PCI with OPCAB38, 39, 40, 41 were powered for stroke, and none reports the extent of “no‐touch” technique in the CABG group. Conversely, one recent trial assessing midterm outcomes of 438 patients randomly assigned to the PCI with everolimus eluting stents and 442 randomly assigned to the CABG group42 found no difference in the risk of stroke between the 2 groups: hazard ratio 0.86 (0.39–1.93); P =0.72. Interestingly, OPCAB was performed in around two thirds of the cases, and arterial revascularization without manipulation of the aorta was encouraged by the study protocol.…”

Section: Discussionmentioning

confidence: 97%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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BackgroundOff‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB.Methods and ResultsPubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients.ConclusionsAortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

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Section: Discussionmentioning

confidence: 97%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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show abstract

“…In a randomized trial of patients with multivessel CAD at 27 centers in East Asia, published in 2015, Park et al found that the MACE rate was higher in patients with PCI using everolimus-eluting stents compared with CABG. 27 Also in 2015, an observational registry study of patients with multivessel CAD reported that the risk of death with PCI utilizing everolimus-eluting stents was similar to that observed for CABG. 28 Obviously, the ultimate superior stent is yet to be found.…”

Section: Multiple Coronary Artery Stentsmentioning

confidence: 90%

Multiple Coronary Artery Interventions

Whayne

2015

Angiology

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“…[3][4][5][6] Interventional cardiologists have made rapid additions to their armamentarium for treating complex CAD through the development of newer-generation drugeluting stents (DES) and novel antithrombotic drugs. At the same time, cardiac surgeons have improved revascularization procedures through the implementation of bilateral left internal mammary artery grafts as well as off-pump and minimally invasive surgery.…”

Section: -A Tale Of Two Cities By Charles Dickensmentioning

confidence: 99%

A Tale of Two Techniques: Demystifying the Myth

Jan¹

2015

Journal of Patient-Centered Research and Reviews

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Trial of Everolimus-Eluting Stents or Bypass Surgery for Coronary Disease

Cited by 423 publications

References 26 publications

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Multiple Coronary Artery Interventions

A Tale of Two Techniques: Demystifying the Myth

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