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[Angioplasty or surgery in the patient with multivessel disease]
J P Monassier1, L Jacquemin, P Ohlmann
1Service de cardiologie, hôpital Emile-Muller, Mulhouse.
Insights
Myocardial revascularization aims to improve survival for patients with multivessel disease. While coronary bypass surgery and angioplasty offer similar survival rates, the choice depends on individual patient factors and procedural outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Context:
- Patients with multivessel coronary artery disease, particularly with proximal lesions, left anterior descending artery involvement, or left ventricular dysfunction, face a poor prognosis.
- Coronary artery bypass grafting (CABG) has demonstrated improved 10-year survival in this high-risk group.
- Percutaneous coronary intervention (PCI) has been extensively compared to CABG in numerous clinical trials.
Purpose:
- To compare the efficacy and outcomes of different myocardial revascularization strategies.
- To evaluate the long-term survival and need for repeat procedures following CABG versus PCI.
- To inform the personalized selection of revascularization procedures based on comprehensive patient and angiographic data.
Summary:
- Medium-term survival rates are comparable between CABG and PCI.
- PCI is associated with a higher rate of repeat procedures, except in diabetic patients where mortality is higher post-PCI.
- Coronary stents may reduce the need for repeat procedures after PCI.
- Ongoing technical advancements in both surgical and interventional techniques, alongside new antiplatelet therapies, influence treatment decisions.
Impact:
- The findings support a personalized approach to myocardial revascularization, tailoring treatment to individual patient profiles.
- Understanding the comparative outcomes of CABG and PCI aids in optimizing patient management and resource allocation.
- Continued research into long-term comparative results is crucial for refining revascularization strategies.
Abstract:
The aims of myocardial revascularisation are to treat angina, reduce ischaemia and improve life expectancy. Patients with multivessel disease have a poor prognosis, especially when the lesions are proximal, when the preseptal left anterior descending artery is involved and when left ventricular dysfunction is present. In this particular group of patients, coronary bypass surgery has been shown to improve 10 year survival. Coronary angioplasty has been compared with surgical treatment in many clinical trials. The medium-term survival is the same in both groups, but with a higher number of repeat procedures except in diabetic patients in whom mortality is higher after angioplasty. The use of coronary stents should reduce the number of post-angioplasty procedures. Constant technical improvements, the introduction of surgery without cardiopulmonary bypass, combined revascularisation procedures, new antiplatelet drugs, the absence of long-term comparative results, all this results in a personalized choice of revascularisation procedure based on the overall clinical and angiography features of each particular case.