Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial of 600 patients with left main disease, the composite endpoint of death, MI, or stroke at 2 years occurred in 4.4% of patients treated with PCI patients and 4.7% of patients treated with CABG, but ischemia-driven target-vessel revascularization was more often required in the patients treated with PCI (9.0% versus 4.2%). 52 The results from these 3 RCTs suggest (but do not definitively prove) that major clinical outcomes in selected patients with left main CAD are similar with CABG and PCI at 1-to 2-year follow-up, but repeat revascularization rates are higher after PCI than after CABG. RCTs with extended follow-up of Ն5 years are required to provide definitive conclusions about the optimal treatment of left main CAD.…”

2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…Although this section will briefly review some special considerations for diagnosis and therapy in certain groups of patients, the general approach should be to apply the recommendations in this guideline consistently among groups. 68 The primary outcome-a composite of death, nonfatal MI, or nonfatal stroke-occurred less frequently in the CABG group (P=0.005), with 5-year rates of 18.7% in the CABG group and 26.6% in the DES group. The benefit of CABG was related to differences in rates of both MI (P<0.001) and death from any cause (P=0.049).…”

“…93 The strongest evidence supporting the use of CABG over PCI for patients with diabetes mellitus and multivessel CAD comes from a published meta-analysis of 8 trials (including FREEDOM). 68 The study of 3131 patients showed that at 5-year or longest follow-up, patients with diabetes mellitus randomized to CABG had a lower all-cause mortality rate than did those randomized to PCI with either DES or bare metal stent (relative risk 0.67; 95% CI: 0.52 to 0.86; P=0.002). 94 In summary, patients with SIHD and diabetes mellitus should receive GDMT.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…69,[72][73][74][75][76][77][78][79][80][81][82][83] A retrospective cohort study of 14 766 consecutive patients undergoing isolated CABG identified a mortality benefit (OR: 0.45) for off-pump CABG in patients with a predicted risk of mortality Ͼ2.5%, 82 but a subsequent randomized comparison of off-pump CABG to traditional on-pump CABG in 341 high-risk patients (a Euroscore Ͼ5) showed no difference in the composite endpoint of all-cause death, acute MI, stroke, or a required reintervention procedure. 78 An analysis of data from the New York State Cardiac Surgery Reporting system did not demonstrate a reduction in mortality rate with off-pump CABG in any patient subgroup, including the elderly (age Ͼ80 years) or those with cerebrovascular disease, azotemia, or an extensively calcified ascending aorta.…”