Debate over patient-centered care: percutaneous coronary intervention or coronary artery bypass grafting?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Coronary artery disease (CAD) is treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
• CABG shows lower mortality than medical management, particularly for high-risk patients.
• Despite evidence favoring CABG, PCI is the most common initial treatment for multivessel CAD.

Purpose of the Study:

• To evaluate the comparative effectiveness of CABG versus PCI for coronary artery disease treatment.
• To assess adherence to treatment guidelines for complex CAD.
• To highlight the importance of a multidisciplinary approach in treatment recommendations.

Main Methods:

• Review of meta-analyses, randomized trials, and registry data comparing CABG and PCI.
• Analysis of the SYNTAX trial comparing drug-eluting stents (DES) with CABG in left main and/or three-vessel CAD.
• Assessment of current treatment recommendation patterns versus established guidelines.

Main Results:

• Recent PCI advancements show no significant improvement in death or myocardial infarction compared to medical therapy.
• Drug-eluting stents (DES) reduced target lesion revascularization compared to bare-metal stents.
• The SYNTAX trial indicated 1-year inferiority of PCI compared to CABG regarding major adverse cardiac and cerebrovascular events.

Conclusions:

• CABG is superior to PCI for survival and freedom from reintervention in complex CAD.
• Current treatment recommendations for CAD often deviate from guidelines, favoring PCI over CABG.
• A multidisciplinary team approach is essential for optimal treatment selection in complex CAD.