Current Clinical Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

Prince, Syma L.; Herbert, Morley A.; Brown, Phillip P.; Katz, Marc; Palmer, George J.; Edgerton, James R.; Eichhorn, Eric J.; Magee, Mitchell J.; Dewey, Todd M.

doi:10.1016/j.athoracsur.2008.03.060

Cited by 30 publications

(14 citation statements)

References 20 publications

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“…mortality between CABG and DES patients overall (6)(7)(8)(9)(10)19); however, diabetic compared with nondiabetic patients had increased mortality after either PES or CABG, demonstrating that neither treatment option can eliminate the increased mortality risk conferred by diabetes (2). The mortality rate in PES-treated diabetic patients requiring insulin was 12.5%, compared with 5.7% in CABG-treated patients taking insulin and 5.8% in PES-treated diabetic patients taking oral medications, although this difference did not reach statistical significance.…”

mentioning

confidence: 99%

Diabetic and Nondiabetic Patients With Left Main and/or 3-Vessel Coronary Artery Disease

Banning

Westaby

Morice

et al. 2010

Journal of the American College of Cardiology

256

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Subgroup analyses suggest that the 1-year major adverse cardiac and cerebrovascular event rate is higher among diabetic patients with left main and/or 3-vessel disease treated with PES compared with CABG, driven by an increase in repeat revascularization. However, the composite safety end point (death/stroke/myocardial infarction) is comparable between the 2 treatment options for diabetic and nondiabetic patients. Although further study is needed, these exploratory results may extend the evidence for PES use in selected patients with less complex left main and/or 3-vessel lesions. (SYNergy Between PCI With TAXus and Cardiac Surgery [SYNTAX]; NCT00114972).

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confidence: 99%

Diabetic and Nondiabetic Patients With Left Main and/or 3-Vessel Coronary Artery Disease

Banning

Westaby

Morice

et al. 2010

Journal of the American College of Cardiology

256

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“…One such study found that that OPCAB and percutaneous angioplasty with sirolimus-coated stents were associated with similar early and late mortality rates, but that the OPCAB patients had a lower rate of reoperation and return of angina [ 117 ]. Likewise, a registry study that found no differences between CABG and OPCAB in terms of outcomes showed that both procedures produced lower 18-month revascularization rates than PCI [ 116 ]. In contrast, a single-center, retrospective study found that the 2-year rates of survival and freedom from major adverse cardiac events were both higher in patients who underwent bypass procedures (83 % of which were OPCAB) than in patients who underwent PCI [ 118 ].…”

Section: Results Of Off-pump Coronary Artery Bypassmentioning

confidence: 93%

“…However, other studies found that choice of procedure made no difference in terms of quality of life at 18 months [ 116 ] or in functional class or treadmill performance at 1 year [ 110 ].…”

Section: Results Of Off-pump Coronary Artery Bypassmentioning

confidence: 96%

Surgical Treatment of Coronary Artery Disease

Cohn

Frazier

Mallidi

et al. 2015

Cardiovascular Medicine

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Techniques and technology for treating coronary artery disease (CAD) have evolved significantly over the past 50 years. Although there are cases in which the best treatment approach (medical, surgical, or catheter-based) is clear, the best choice of intervention is not obvious for the majority of patients. Five, seven, and ten years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar short-term survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CABG has been associated with longer-lasting revascularization.Technical innovations made in the attempt to reduce the negative impact of cardiopulmonary bypass (CPB) include reducing contact between blood and the CPB mechanism by coating the internal surface with heparin or other polymers, minimizing hemodilution by shrinking the bypass circuit to reduce the amount of crystalloid prime needed to start CPB, and using hemofi ltration to protect the heart and end organs. There is not yet complete agreement about the relative safety and effi cacy of off-pump coronary artery bypass (OPCAB) versus conventional CABG with CPB.Results of small randomized trials suggest that, in patients with stenosis of the proximal LAD, minimally invasive direct coronary artery bypass (MIDCAB) is associated with a longer in-hospital recovery period and higher costs than is direct stenting, but that MIDCAB produces similar or better short-and long-term outcomes. Totally endoscopic coronary artery bypass (TECAB) aided by computer-controlled surgical robotic devices has continued to slowly evolve over the last decade, and several centers have reported favorable results. The technical challenges and procedural costs have prevented the widespread application of this technology. • Techniques and technology for treating coronary artery disease (CAD) have evolved signifi cantly over the past 50 years.• Although there are cases in which the best treatment approach (medical, surgical, or catheterbased) is clear, the best choice of intervention is not obvious for the majority of patients.• Five, 7, and 10 years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.• Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar shortterm survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CA...

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“…Although off-pump coronary artery bypass grafting (CABG) has shown some particular benefits including shorter operating time, rapid recovery, and lower rate of revascularization, 9 the occurrence of major adverse cardiac and cerebrovascular events is similar as drug (sirolimus)-eluting stent (DES). 10, 11 As a result of diabetic peripheral angiopathy, the available vessel for CABG from the patient is also limited. Therefore, patient-derived MSC show great potential in future applications.…”

Section: Clinical Perspectivementioning

confidence: 99%