Will drug-eluting stents replace coronary artery bypass surgery?

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology Assessment

Background:

• Percutaneous coronary intervention (PCI), especially with drug-eluting stents (DESs), is increasingly popular for coronary artery disease (CAD).
• Speculation exists that PCI may eventually replace coronary artery bypass grafting (CABG).

Purpose of the Study:

• To evaluate the continued role of CABG in CAD treatment compared to PCI.
• To assess the long-term viability and benefits of CABG in light of advancements in PCI.

Main Methods:

• Review of published randomized trials comparing CABG and PCI.
• Analysis of patient selection criteria in trials comparing revascularization strategies.
• Evaluation of revascularization completeness, repeat revascularization rates, and graft patency data.

Main Results:

• Many trials comparing CABG and PCI used highly selected patient subgroups, potentially favoring PCI outcomes.
• CABG provides more complete revascularization and better freedom from repeat procedures.
• Long-term patency data for CABG grafts (e.g., LIMA-LAD) are well-established, unlike for DESs.

Conclusions:

• CABG is unlikely to become obsolete due to PCI advancements.
• Both CABG and PCI have ongoing technological improvements.
• CABG remains a vital and effective treatment option for specific CAD patient populations.