(January 23, 2008 - Insidermedicine) In patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) produces better outcomes than coronary stenting with a drug-eluting stent, according to research published in the New England Journal of Medicine.

Here are some recommendations from the European Society of Cardiology regarding the decision to use drug-eluting stents:

•    Indications for these devices are not yet clear, so the decision to use then can be made based on cost-effectivess analyses or inclusion/exclusion criteria from clinical trials.

•    Drug-eluting stents can be considered for patients with symptomatic coronary artery disease in whom the target artery has an internal diameter under 3 mm or in whom the target lesion is over 15 mm. This does not apply to patients who have had a myocardial infarction in the previous 24 hours or in whom there is angiographic evidence of thrombus.

•    The following indications for drug-eluting stents require further evidence-based evaluation: small vessels, chronic total occlusions, bifurcational/ostial lesions, bypass stenosis, insulin-dependent diabetes mellitus, multivessel disease, unprotected left main stenosis, and in-stent restenosis.

Researchers out of the State University of New York at Albany compared outcomes of nearly 10,000 patients who received drug-eluting stents with over 7,400 patients who underwent CABG for multivessel disease in New York State.

Patients who underwent CABG had lower 18-month mortality rates from all causes and from myocardial infarction than those who received drug-eluting stents. Among patients with three vessel disease,  ith an  adjusted hazard ratio for death of 0.80, patients were 20% less likely to die and 25% less likely to suffer death or myocardial infarction for those who received CABG, compared with those who received stents. Similarly, among those with two vessel disease, the adjusted hazard ratio for death as well as for death or myocardial infarction was 0.71 for CABG vs. stenting. Patients who underwent CABG also had fewer repeat revascularizations.

Today's research demonstrates that, despite the advanced technology associated with drug-eluting stents, CABG still offers better outcomes in terms of survival, risk of myocardial infarction, and need for revascularization than stenting for patients with multivessel disease.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.