Our data demonstrate a significant mortality benefit with CABG over percutaneous coronary intervention (PCI), and this benefit is consistent across virtually all major patient groups; so suggesting that CABG should be consider in broader patient populations, not just in cases of patients with diabetes and left ventricular dysfunction; which is what is commonly practice.
Those who met the eligibility criteria were separate into two groups CABG and PCI each including 844 patients.The analyses focused on outcomes for mortality, readmission and revascularization. The researchers find that the estimate one year mortality for patients in the CABG group was 7.2%; so as compare to 11.5% the PCI group. The CABG group also experience lower risk of hospital readmission and revascularization than the PCI group.
Randomize clinical trials
A major point in the study is the focus on the current era of revascularization with the most currently available stents,” said Dr. Mulukutla. This research is really a modern, ‘real-world’ experience. While randomize clinical trials are clearly important, real-world analyses also can very instructive; hence because they provide insights on how we are making clinical decisions. For instance, the last several years have seen a shift toward more PCI over CABG.
While there may be valid reasons for this, our data; which show CABG outperforming PCI in almost every patient group push us to further discuss all of the options. PCI, often refer to as angioplasty, is a nonsurgical procedure that uses a thin; so flexible catheter placed into an artery in the groin or arm. A balloon on the end of the catheter is position; which in the narrow coronary artery and inflate to open-up the blockage.
A stent is a metal mesh tube that is left behind to help keep the artery from collapsing. Drugs attach to the stent help prevent the body from reacting to the stent and shutting down the artery again. CABG, the most commonly perform heart operation in the United States; so is design to bypass the blockages in the coronary arteries in order to create a new path for blood flow to the heart.
Healthy blood vessel
The surgeon removes a healthy blood vessel; so usually from the leg, arm, chest, or abdomen, and connects it to the other arteries in the heart. This enables blood flow to “bypass” or go around the disease or block portion of the coronary artery. The decision between open heart surgery and PCI for treatment of patients with multiple narrow arteries is not always straightforward. Thus, these more complex treatment decisions made with the guidance of a heart care team.
Both cardiac surgery and stenting have roles among patients with coronary artery disease,” said Dr. Mulukutla. “Because of this, it is important to deliberate carefully with the help of a heart team. The team can ensure that a multidisciplinary approach is use when offering recommendations to patients and assisting them in making inform decisions.
With revascularization, heart team input is often limit because PCI can complete at the time of a patient’s diagnostic procedure. When this happens, the physicians do not have the opportunity to discuss the spectrum of possible treatment options. As a result, the practical and consistent use of the heart team for decision-making in the treatment of patients with complex coronary artery diseases is lacking, Dr. Mulukutla explained.
They are working to better facilitate a heart team approach and overcome some of the limitations give the current infrastructure of how these decisions are made,” said Dr. Mulukutla. “We also are continuing to identify specific patient populations that may benefit from either CABG or PCI so that we can best advocate for our patients.