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Clinical evidence versus patients' perception of coronary revascularization

Michio Kawasuji1

  • 1Department of Cardiovascular Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo-ku, Kumamoto 860-8556, Japan. kawasuji@kumamoto-u.ac.jp

Surgery Today
|January 4, 2013
PubMed

Insights

Coronary artery bypass grafting (CABG) shows better survival than percutaneous coronary intervention (PCI) for complex coronary artery disease. Patients need unbiased information on revascularization risks and benefits from a Heart Team.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) is treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
  • CABG offers survival benefits for high-risk patients, while PCI is less invasive and frequently used for multi-vessel disease.
  • PCI has shown no additional benefit over medical therapy regarding myocardial infarction (MI) or death.

Purpose of the Study:

  • To compare the 4-year outcomes of CABG versus PCI with drug-eluting stents in patients with left main and/or three-vessel coronary artery disease.
  • To evaluate all-cause mortality and cardiac death between the two revascularization strategies.

Main Methods:

  • The SYNTAX trial prospectively compared CABG and PCI outcomes.
  • Included patients had left main and/or three-vessel coronary artery disease.
  • Outcomes were assessed over a 4-year follow-up period.

Main Results:

  • All-cause mortality was significantly higher in the PCI group compared to the CABG group.
  • Cardiac death rates were also significantly higher in the PCI group than in the CABG group.
  • Despite evidence, PCI is often recommended over CABG, contrary to guidelines.

Conclusions:

  • CABG demonstrates a survival advantage over PCI in patients with complex coronary artery disease (left main and/or three-vessel disease).
  • PCI is frequently recommended more often than indicated, potentially leading to suboptimal patient outcomes.
  • An informed consent process, facilitated by a Heart Team, is crucial for patients undergoing revascularization for coronary artery disease.

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