PCI and CABG for Treating Stable Coronary Artery Disease

Doenst, Torsten; Haverich, Axel; Serruys, Patrick W.; Bonow, Robert O.; Kappetein, Pieter; Falk, Volkmar; Velázquez, Eric J.; Diegeler, Anno; Sigusch, Holger H.

doi:10.1016/j.jacc.2018.11.053

Cited by 300 publications

(198 citation statements)

References 67 publications

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“…PCI advocates cite advances in stents, methodology recovery time, and lower perioperative stroke rates, while CABG advocates cite greater medium-and long-term survival, lower fatal and nonfatal event rates, less need for repeat revascularization compared to PCI, and possibly improved quality of life [20][21][22]. In patients with very high CHD risk, complex coronary lesions or diabetes, classical evidence supports the use of CABG [2,14,[23][24][25]. The findings and commentary apply only to this patient population; in other applications, transcatheter techniques may be lifesaving and can provide advantages that surgery cannot offer.…”

Section: Discussionmentioning

confidence: 99%

“…PCI targets only the flow-limiting lesions but has the advantage of being less invasive than CABG, with lower upfront morbidity and mortality, and shorter recovery time." However, revascularization is much more complete with CABG, and according to Doenst et al [25], the majority of MIs are generated by non-flow-limiting stenoses. The extent of repeat revascularization with PCI is appreciably greater as compared with CABG, and MI may be increased.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

Rumana

Kones²,

Taheer

et al. 2019

JCDD

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In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 (p = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ2 (7) = 308.850, p < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with p < 0.05, but ethnicity ‘Unknown’ did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

Rumana

Kones²,

Taheer

et al. 2019

JCDD

View full text Add to dashboard Cite

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“…The Journal of Thoracic and Cardiovascular Surgery c Volume -, Number -patients against a new MI. 67 MI remains the leading cause of death following PCI. 68 The etiologies of recurrent MACE differ following CABG and PCI.…”

Section: Factors Responsible For Poor Compliance With Gdmt In Cabg Pamentioning

confidence: 99%

The surgeon's role in optimizing medical therapy and maintaining compliance with secondary prevention guidelines in patients undergoing coronary artery bypass grafting

Lazar

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…Since the graft lands in the distal two‐third of vessels, it also stabilizes those plaques that are not flow‐limiting at the time of the coronary revascularization but that may be at high risk for rupturing or causing vessel occlusion in the future. The so‐called “surgical collateralization effect” of CABG over PCI is independent of any stent generation and assumes a crucial role, particularly when arteries are used as conduits for CABG 4 …”

Section: Introductionmentioning

confidence: 99%

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

et al. 2020

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Background and Aim of the Study: Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. Methods and Results: In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. Conclusions: In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement. K E Y W O R D S CABG, coronary artery bypass grafting, coronary artery disease, multiarterial revascularization, total arterial revascularization

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PCI and CABG for Treating Stable Coronary Artery Disease

Cited by 300 publications

References 67 publications

Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

The surgeon's role in optimizing medical therapy and maintaining compliance with secondary prevention guidelines in patients undergoing coronary artery bypass grafting

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

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