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Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease
Serruys PW, Morice MC, Kappetein AP, et al.
Reviewed by: Hong Liu, MD
Objectives and Background
Results and Conclusions
CABG was introduced in 1968 and rapidly became the standard of care for symptomatic patients with CAD. Since the introduction of PCI in 1977 and with the great improvement in technology, PCI has been used to treat increasingly complex lesions and patients with a history of clinically significant cardiac disease, risk factors for coronary artery disease, coexisting conditions, or anatomical risk factors. There are many clinical studies comparing CABG and PCI, but most of these studies were smaller and nonrandomized. In this international, multicenter, randomized, controlled comparison of CABG vs. PCI with drug-eluting stents in 1800 patients, all of them with left main or three-vessel CAD, CABG was proven to be superior to PCI for the primary end point, the 12-month rate of major adverse cardiac or cerebrovascular events. This was mainly driven by the increased need for revascularization in the PCI group. For the secondary outcomes, the results were mixed. The authors designed SYNTAX score to predict outcomes related to anatomical characteristics and, to a lesser extent, the functional risk of occlusion for any segment of the coronary-artery bed. There was also a significant relationship between SYNTAX score and treatment group. Patients with low or intermediate scores in the CABG group and in the PCI group had similar rates of major adverse cardiac or cerebrovascular events, whereas among patients with high scores, the event rate was significantly increased in the PCI group. Although this study provides important information about current treatment of CAD, there are limitations. First, the 12-month follow-up period may not be sufficient to reflect the true long-term effect of CABG as compared with PCI with drug-eluting stents on cardiac-related health. Second, the use of antiplatelet medication was high among patients in the PCI group. Third, more patients withdrew, after randomization, from the CABG group than from the PCI group. From this 12-month study, CABG remains the standard of care for patients with three-vessel or left main CAD. This study was also designed to have a 4-year follow-up period, so that we’ll be able to see the outcomes over a longer period of time.
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