CABG vs. PCI Survival Advantage Confirmed, Again

STS News, Summer 2012 -- With the full results now available from the ASCERT (American College of Cardiology Foundation-The Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) trial, the clinical impact of the study – particularly that it will change how physicians advise patients on their options for revascularization – recently took center stage during an STS-hosted “virtual town hall” meeting.

This roundtable, phone-in discussion at the AATS 92nd Annual Meeting in San Francisco gave STS and ACC leaders, as well as ASCERT principal investigators, the opportunity to explore important issues, such as what ASCERT means to clinical practice.

Published in the April 19, 2012 issue of The New England Journal of Medicine, the ASCERT study used the clinical databases of both STS and ACC, as well as data from CMS, to obtain long-term follow-up information on patients undergoing coronary artery bypass grafting (CABG) and patients undergoing percutaneous coronary intervention (PCI).

Led by principal investigators Fred H. Edwards, MD, Director of the STS Research Center, and William S. Weintraub, MD, representing ACC, ASCERT looked at more than 185,000 Medicare patients undergoing coronary revascularization from 2004 to 2008. It represents the most comprehensive observational study to date of revascularization outcomes in U.S. patients at least 65 years of age.

Overall, first-year survival favored stent placement; however, beyond the first year of revascularization, patients showed a clear CABG survival advantage that progressively increased over time.

“The focus of the ASCERT study was on ‘real world’ Medicare patients,” said Dr. Edwards. “This study was carefully designed by both cardiologists and cardiothoracic surgeons to produce reliable results based on an exhaustive statistical analysis.”

Previous state and regional observational studies showed a long-term survival advantage for CABG. “The ASCERT results confirm that the CABG survival advantage is also seen in a large nationwide population,” said Dr. Edwards. “ASCERT now offers patients a comprehensive look at the comparative effectiveness of open heart surgery and stent procedures, with solid evidence of a survival advantage for surgery.”

To access the audio recording of the ASCERT town hall meeting, visit