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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EPercutaneous coronary intervention with second-generation everolimus-eluting stents was inferior to coronary artery bypass graft surgery in patients with multivessel coronary artery disease in the open-label prospective randomized BEST trial. The composite primary outcome (all-cause death, myocardial infarction, target vessel revascularization) occurred more frequently in patients randomized to percutaneous coronary intervention.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00997828\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPCI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECABG\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebypass surgery\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBEST\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECAD\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edrug-eluting stent\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eeverolimus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003ELong-term data from the prospective open-label BEST trial found percutaneous coronary intervention (PCI) with a second-generation drug-eluting stent to be inferior to coronary artery bypass graft (CABG) surgery in patients with multivessel coronary artery disease (CAD), according to Seung-Jung Park, MD, PhD, Asan Medical Center, Seoul, Korea [Park SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015].\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003ERecent studies have found that CABG surgery is associated with lower rates of adverse outcomes in patients with multivessel CAD when compared with PCI. The BEST trial was designed as a randomized noninferiority trial that compared optimal revascularization with PCI using everolimus-eluting stents to CABG in patients with multivessel CAD.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EA total of 880 patients from 4 countries in East Asia with angina and\/or objective evidence of a myocardial ischemia and multivessel CAD confirmed by angiography were enrolled in the trial. The study was terminated early because of slow enrollment.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EPatients were randomly assigned to PCI (n\u2005=\u2005438) or CABG (n\u2005=\u2005442), although crossovers and other treatment changes occurred. The primary end point was the composite of major adverse cardiac events (all-cause death, myocardial infarction [MI], and target vessel revascularization) at 2 years. Key secondary end points included stroke, new lesion revascularization, and TIMI major bleeding.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EFollow-up was performed with either a clinic visit or phone interview at 30 days; 6, 9, and 12 months; and then annually. Medications for secondary prevention (aspirin, statins) were strongly recommended, and routine angiography in the absence of ischemia was discouraged.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EThe composite primary end point occurred in 11.0% of PCI patients and 7.9% of CABG patients at 2 years with an absolute risk difference of 3.1 percentage points (95% CI, \u20130.8 to 6.9; \u003Cem\u003EP\u003C\/em\u003E\u003Csub\u003ENoninferiority\u003C\/sub\u003E\u2005=\u2005.32). The incidence of the primary outcome was significantly higher in the PCI group vs the CABG group at 5 years (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). CABG performed better for the primary end point in all of the prespecified subgroups. As shown in \u003Ca id=\u0022xref-table-wrap-1-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E, some secondary outcomes were increased at 5 years in the PCI group vs the CABG group, while TIMI major bleeding was significantly lower.\u003C\/p\u003E\n\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16194\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16194\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16194\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EIncidence of Primary and Secondary Outcomes at 5 Years\u003Csup\u003E*\u003C\/sup\u003E\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-15\u0022\u003EIn conclusion, the BEST trial found that PCI with the second-generation everolimus-eluting stent was inferior to CABG for the primary end point of all-cause death, MI, or target vessel revascularization at 2 years. Patients randomized to PCI had an increased risk of all-cause death, MI, and target vessel revascularization that remained present at 5 years.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/5\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzloxp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzloxp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}