Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial

Ahn JM 1 , Kang DY 1 , Yun SC 2 , Ho Hur S 3 , Park HJ 4 , Tresukosol D 5 Show all authors , Chol Kang W 6 , Moon Kwon H 7 , Rha SW 8 , Lim DS 9 , Jeong MH 10 , Lee BK 11 , Huang H 12 , Hyo Lim Y 13 , Ho Bae J 14 , Ok Kim B 15 , Kiam Ong T 16 , Gyun Ahn S 17 , Chung CH 1 , Park DW 1 , Park SJ 1 , BEST Extended Follow-Up Study Investigators

Affiliations 

  • 1 Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  • 2 Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  • 3 Keimyung University Dongsan Medical Center, Daegu, South Korea (S.H.H.)
  • 4 Catholic University of Korea, Seoul St. Mary's Hospital (H.-J.P.)
  • 5 Siriraj Hospital, Bangkok, Thailand (D.T.)
  • 6 Gachon University Gil Hospital, Incheon, South Korea (W.C.K.)
  • 7 Gangnam Severance Hospital, Seoul, South Korea (H.M.K.)
  • 8 Korea University Guro Hospital, Seoul (S.-W.R.)
  • 9 Korea University Anam Hospital, Seoul (D.-S.L.)
  • 10 Chonnam National University Hospital, Gwangju, South Korea (M.-H.J.)
  • 11 Kangwon National University Hospital, Chuncheon, South Korea (B.-K.L.)
  • 12 Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China (H.H.)
  • 13 Hanyang University Hospital, Seoul, South Korea (Y.H.L.)
  • 14 Konyang University Hospital, Daejeon, South Korea (J.H.B.)
  • 15 Inje University Sanggye Paik Hospital, Seoul, South Korea (B.O.K.)
  • 16 Sarawak General Hospital, Kuching, Sarawak, Malaysia (T.K.O.)
  • 17 Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea (S.G.A.)
Circulation, 2022 Nov 22;146(21):1581-1590.
PMID: 36121700 DOI: 10.1161/CIRCULATIONAHA.122.062188

Abstract

BACKGROUND: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease.

METHODS: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization.

RESULTS: During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG.

CONCLUSIONS: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up.

REGISTRATION: URL: https://www.

CLINICALTRIALS: gov; Unique identifiers: NCT05125367 and NCT00997828.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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