Related Experiment Video

Updated: Aug 24, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.1K

Revascularization strategies versus optimal medical therapy in chronic coronary syndrome: A network meta-analysis

Mattia Galli1, Stefano Benenati2, Andrea Zito3

  • 1Catholic University of the Sacred Heart, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.

International Journal of Cardiology
|October 20, 2022
PubMed

Insights

For chronic coronary syndrome patients without left main disease, physiology-guided PCI and CABG offer better outcomes than angiography-guided PCI. Coronary artery bypass grafting significantly reduces myocardial infarction and death but increases stroke risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Chronic Coronary Syndrome (CCS) management without left main (LM) disease or reduced left ventricle ejection fraction (LVEF) may depend on revascularization strategy.
  • Evaluating optimal revascularization strategies is crucial for patient prognosis.

Purpose of the Study:

  • To compare the effectiveness of different myocardial revascularization strategies in patients with CCS without LM disease or reduced LVEF.
  • To assess outcomes associated with angiography-guided PCI, physiology-guided PCI, and CABG versus medical therapy.

Main Methods:

  • Network meta-analysis of 18 randomized controlled trials.
  • Inclusion of patients with CCS, excluding those with LM disease or reduced LVEF.
  • Comparison of angiography-guided PCI, physiology-guided PCI, and CABG.

Main Results:

  • All revascularization strategies reduced the primary endpoint compared to medical therapy.
  • Physiology-guided PCI and CABG showed greater reductions than angiography-guided PCI.
  • CABG was associated with reduced myocardial infarction, cardiovascular death, and all-cause death, but increased stroke risk.

Conclusions:

  • Physiology-guided PCI and CABG yield better outcomes than angiography-guided PCI in CCS patients without LM disease or reduced LVEF.
  • CABG is the only strategy reducing myocardial infarction and death rates, albeit with a higher stroke risk.
Abstract

Keywords:
AngiographyCoronary artery bypassFractional flow reservePercutaneous coronary interventionPhysiologyRevascularization

More Related Videos

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis04:30

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

25.6K
Author Spotlight: Enhancing Coronary Artery Revascularization05:25

Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

814

Related Concept Videos

Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
22
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
23
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
19
Angina IV: Management01:26

Angina IV: Management

IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
16
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
20
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
26