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Posted by on Apr 22, 2014 in Coronary artery disease | 0 comments

In a nutshell

This study compared the effects of percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) on long term mortality and morbidity in patients with multivessel coronary artery disease.

Some background

Coronary artery disease, characterized by narrowing of the arteries and disrupted blood supply to the heart muscle, is a leading cause of death worldwide. Therefore, many therapies aim to restore optimal blood supply in order to reduce the risk of future fatal heart attacks. Multivessel coronary artery disease, which involves more than one of the major coronary arteries, often requires aggressive surgical intervention in order to restore proper blood flow to the heart muscle.

Coronary artery bypass grafting (CABG) is a surgical procedure in which the blocked coronary artery is bypassed by another piece of blood vessel that was harvested from the patient's body (usually from the leg or chest). Recent improvements in surgical techniques and better postoperative monitoring have led to improved outcomes in patients with multivessel coronary artery disease undergoing CABG surgery.

Percutaneous coronary intervention (PCI) is a nonsurgical therapy, restoring normal blood flow by inserting a small catheter equipped with an inflatable balloon (through an artery in the hand or hip) into the narrowed artery of the heart. Often, a stent (a small mesh tube) is placed within the vessel to help keep the artery open. Recent advances such as replacement of the ordinary stents with drug secreting stents have also led to improved prognosis in patients with coronary artery disease undergoing PCI. As both methods continue to evolve, the optimal treatment strategy for multivessel coronary artery disease must remain well defined.

Methods & findings

This analysis compared the effect of CABG and PCI among patients with multivessel coronary artery disease. 6 randomly controlled trials, enrolling a total of 6,055 patients, were reviewed in the analysis. Overall, 3,023 patients underwent CABG surgery, while 3,032 were randomized to undergo PCI. After an average follow up of 4.1 years, analysis showed that CABG reduced the risk of mortality by 27% compared with PCI. Further analysis showed a 42% risk reduction in further heart attacks in patients randomized to CABG compared with patients randomized to PCI.

The bottom line

This analysis concluded that among patients with multivessel coronary artery disease, CABG results in a significant reduction in mortality and morbidity compared with PCI.

Published By :

JAMA Internal Medicine

Date :

Dec 02, 2013

Original Title :

Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention and Long-term Mortality and Morbidity in Multivessel Disease: Meta-analysis of Randomized Clinical Trials of the Arterial Grafting and Stenting Era.

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