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      Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting

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          Abstract

          Introduction

          Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two common treatment options used in patients suffering from coronary artery disease. Selection and favorability of one over the other depend on individual clinical scenarios. The purpose of this study is to compare outcomes after treatment with PCI and CABG.

          Methods

          This longitudinal observational study was conducted from April 2018 to July 2019 in a cardiovascular unit of a tertiary care hospital. Participants who were eligible for revascularization were randomized either to receive stent (PCI) or surgery (CABG). Patients were then followed up for 12 months for the development of all-cause mortality and major adverse cardiovascular events (MACEs).

          Results

          At 12 months, patients randomized to the PCI group had an increased risk of repeat revascularization (21.3% vs. 7.4%; p = 0.007), whereas a similar number of patients in both groups died (3.8% vs. 3.7%), suffered myocardial infarction (7.6% vs. 5.6%), or had a cerebrovascular accident (3.8% vs. 2.8%).

          Conclusions

          This study showed that PCI had an increased risk of repeat revascularization compared to CABG. However, both had comparable significance in the development of MACEs. Nevertheless, there is a need for further study to better assess the outcomes of either, especially in the long run. 

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          Most cited references11

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          PCI and CABG for Treating Stable Coronary Artery Disease

          Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non-flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing "surgical collateralization," prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
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            Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial.

            Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents. SYNTAX is an 85-centre randomized clinical trial (n= 1800). Prospectively screened, consecutive LM and/or 3VD patients were randomized if amenable to equivalent revascularization using either technique; if not, they were entered into a registry. Patients in the randomized cohort will continue to be followed for 5 years. At 3 years, major adverse cardiac and cerebrovascular events [MACCE: death, stroke, myocardial infarction (MI), and repeat revascularization; CABG 20.2% vs. PCI 28.0%, P< 0.001], repeat revascularization (10.7 vs. 19.7%, P< 0.001), and MI (3.6 vs. 7.1%, P= 0.002) were elevated in the PCI arm. Rates of the composite safety endpoint (death/stroke/MI 12.0 vs. 14.1%, P= 0.21) and stroke alone (3.4 vs. 2.0%, P= 0.07) were not significantly different between treatment groups. Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the LM subgroup (22.3 vs. 26.8%, P= 0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8%, P< 0.001). At 3 years, MACCE was significantly higher in PCI- compared with CABG-treated patients. In patients with less complex disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM patients), PCI is an acceptable revascularization, although longer follow-up is needed to evaluate these two revascularization strategies.
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              Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery.

              Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown. In a large, randomized trial, we assigned 1800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxel-eluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status). The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P=0.04 and P=0.03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%, P=0.05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period. Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.).
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                21 December 2020
                December 2020
                : 12
                : 12
                : e12202
                Affiliations
                [1 ] Cardiology, Khairpur Medical College, Nawabshah, PAK
                [2 ] Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
                [3 ] Cardiology, Sheikh Zayed Medical College, Rahim Yar Khan, PAK
                [4 ] Internal Medicine, Taluka Hospital Kandhkot, Kandhkot, Kashmore, PAK
                [5 ] Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
                [6 ] Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
                [7 ] Family Medicine, Jinnah Post Graduate Medical Center, Karachi, PAK
                Author notes
                Article
                10.7759/cureus.12202
                7815293
                47a3badb-d740-4b1b-935c-74cbf233f6eb
                Copyright © 2020, Kumar et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 December 2020
                Categories
                Cardiac/Thoracic/Vascular Surgery
                Cardiology
                Internal Medicine

                percutaneous coronary intervention,coronary artery bypass grafting,myocardial infarction

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