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Ann Thorac Surg 2006;81:1949-1957
© 2006 The Society of Thoracic Surgeons

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Editorial review

Coronary Artery Bypass is Superior to Drug-Eluting Stents in Multivessel Coronary Artery Disease _^*

Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

^_* Address correspondence to Dr Guyton, Section of Cardiothoracic Surgery, The Emory Clinic, 1365 Clifton Rd, Atlanta, GA 30322 (Email: robert_guyton{at}emoryhealthcare.org).

Percutaneous intervention for the treatment of multivessel coronary artery disease continues to displace coronary artery bypass graft surgery. But controlled trials of percutaneous intervention versus coronary bypass, in meta-analysis, have shown a significant survival advantage for coronary bypass. Studies of bare metal stents have not presented any data to prompt reversal of this conclusion for all but the small portion of patients most suited for stenting. Drug-eluting stents have no survival advantage compared with bare metal stents. Data from real-world registries have shown that the current therapy of multivessel disease patients has resulted in a relative excess mortality of as much as 46% in patients with initial stenting compared with patients with initial coronary bypass. Ethical considerations demand that patients with multivessel disease be informed of the documented mortality benefit of coronary bypass graft surgery.

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