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N Engl J Med. 2009 Mar 5;360(10):961-72. doi: 10.1056/NEJMoa0804626. Epub 2009 Feb 18.

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.

Collaborators (191)

Mooney M, Kroshus T, Zijlstra F, Boonstra PW, Vermeersch P, Van Cauwelaert P, Glogar D, Grimm M, Den Heijer P, Vrakking MM, Stoler R, Henry AC, Zelman R, Rizzo R, Cannon LA, Vazales B, Koolen J, Schonberger JP, Carrié D, Fournial G, Eltchaninoff H, Bessou JP, Legrand V, Limet R, Marco J, Soula P, Berland J, Bessou JP, Darremont O, Fernandez G, Serruys PW, Kappetein AP, Feldman TE, Chedrawy E, Taussig A, Accola KD, Dobies D, Silver M, Gershlick AH, Spyt TJ, Horvath IG, Papp L, Wiemer M, Seifert D, Schuler G, Mohr FW, Santos Rodriguez I, Gonzalez Santos JM, Macaya C, Rodriguez E, Betriu A, Pomar JL, Ferreira C, Fragata J, Ruiz JM, Llamas PJ, Morice MC, Farge A, Ruzyllo W, Religa Z, Aschermann M, Tosovsky J, Bramucci E, d'Armini A, Suryapranata H, Bruinsma H, Bruinsma GJ, Presbitero P, Gallotti R, Berti S, Glauber M, Dudek D, Sadowski J, Banning A, Westaby S, Ho P, Chen J, Jensen J, Lockowandt U, Thomas MR, Desai JB, Boekstegers P, Reichart B, Hauptmann KE, Muller V, Rothman MT, MaGee P, Bode C, Beyersdorf F, Kellett MA, Kramer RS, Holmes DR, Schaff HV, Brown DL, Mack MJ, Edes I, Peterffy A, Drzewiecki J, Buszman P, Bochenek A, Hartmann F, Sievers H, Virtanen K, Harjula AL, Chang M, Kaplon R, Preda I, Tarr F, McGarry T, Lucas SK, de Bruyne B, Wellens F, Reimers B, Giacomin A, Guagliumi G, Ferrazzi P, Erglis A, Lacis R, Possati G, Crea F, Endresen K, Svennevig J, Minor R, Locher J, De Belder A, Forsyth A, Albertsson P, Wiklund L, Kiesz S, Otero C, Colombo A, Torracca L, Stine R, Azar H, Thuese L, Hostrup PN, Buckner K, Guber M, Wolschleger K, Heiser JC, Redwood S, Venn G, Suttorp M, van Boven WJ, Heyrich G, Deshpande A, Brown D, Seifert F, Heigert M, Unger F, Taeymans Y, Van Nooten G, Simon R, Cremer J, Meinertz T, Reichenspurner HC, Bocksch W, Rutsch W, Dohmen P, Dawkins KD, Livesey SA, James S, Stahle E, Olivecrona G, Ingemansson R, Horwitz P, Everett J, Mann T, Killinger W, Satler L, Boyce SW, Oldroyd KG, Berg G, Babikian VL, Birnbaum D, Carrel TP, Gorman M, Hanet C, Hess OM, Jansen EW, Kappelle LJ, Steg PG, Bassand JP, Clayton T, Faxon DP, Gersh BJ, Monro JL, Pocock S, Turina MI, Roy K, Pereda P.

Erratum in

  • N Engl J Med. 2013 Feb 7;368(6):584.



Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both).


We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry.


Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003).


CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. ( number, NCT00114972.)

2009 Massachusetts Medical Society

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