Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease (BEST)

Inclusion Criteria:

• Age 18 years of older

• Angiographically confirmed multivessel CAD [critical (>70%) lesions in at least twomajor epicardial vessels and in at least two separate coronary artery territories (LAD, LCX, RCA)] and amenable to either PCI or CABG.

• Indication for revascularization based upon symptoms of angina and/or objectiveevidence of myocardial ischemia

• Geographically accessible and willing to come in for required study visits

• Signed informed consent.

Exclusion Criteria:

• Severe congestive heart failure (class III or IV according to NYHA, or pulmonaryedema) at the time of enrollment.

• Planned simultaneous surgical procedure unrelated to coronary revascularization (e.g.valve repair/replacement, aneurysmectomy, carotid endarterectomy or carotid stent).

• In-stent restenosis of a target vessel

• Prior CABG surgery

• Prior PCI with stent implantation within 1 year

• Two or more chronic total occlusions in major coronary territories

• Acute ST-elevation MI(Q-wave) within 72 hours prior to enrollment requiringrevascularization

• Abnormal creatine kinase (CK > 2x normal) and/or abnormal CK-MB levels and/or elevatedTroponin levels at time of randomization

• Previous stroke within 6 months or patients with stroke at more than 6 months withsignificant residual neurologic involvement, as reflected in a Rankin Score > 1

• Dementia with a Mini Mental Status Examination (MMSE) score of ≤ 20

• Extra-cardiac illness that is expected to limit survival to less than 2 years; e.g.oxygen-dependent chronic obstructive pulmonary disease, active hepatitis orsignificant hepatic failure, severe renal disease.

• Prior history of significant bleeding (within the previous 6 months) that might beexpected to occur during CABG or PCI/DES related anticoagulation.

• Contraindication either CABG or PCI/DES because of a coexisting clinical condition

• Significant leucopenia, neutropenia, thrombocytopenia, anemia, or known bleedingdiathesis

• Intolerance or contraindication to aspirin or both clopidogrel and ticlopidine

• Suspected pregnancy. A pregnancy test (urine or serum) will be administeredprerandomization to all women not clearly menopausal

• Concurrent enrollment in another clinical trial