Authors: Michio Kawasuji
Publish Date: 2011/03/23
Volume: 41, Issue: 4, Pages: 459-
Abstract
Coronary artery bypass grafting CABG and percutaneous coronary intervention PCI have developed as effective therapies to treat coronary artery disease Initial CABG is associated with lower mortality than initial medical management especially among high and intermediaterisk patients with coronary artery disease However PCI is currently the most frequent initial treatment delivered by interventional cardiologists to treat multivessel coronary artery disease despite substantial evidence from metaanalyses of randomized trials and registry data favoring CABG Recent advancements in PCI did not result in detectable improvements in death or myocardial infarction compared with medical therapy although significant reductions in target lesions or vessel revascularization were identified after implantation of a drugeluting stent DES rather than a baremetal stent The SYNTAX trial compared patients with left main and/or threevessel coronary artery disease treated with DES or CABG The results of the trial demonstrated the 1year inferiority of PCI compared with CABG with respect to major adverse cardiac and cerebrovascular events Nevertheless patients with coronary artery disease continue to receive more recommendations for PCI and fewer for CABG than are indicated in the guidelines A multidisciplinary team approach should be the standard of care when recommending interventions for treating complex coronary artery disease among patients for whom CABG is superior in terms of survival and freedom from reintervention
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