[Comparative studies of PTCA versus bypass operation: rationale for patient-oriented therapy]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Multivessel coronary artery disease requires treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
• Previous randomized trials have compared these revascularization strategies with varying results.

Purpose of the Study:

• To compare the long-term clinical outcomes and risks of PCI versus CABG in patients with symptomatic multivessel coronary disease.
• To evaluate the impact of diabetes mellitus on treatment outcomes.
• To assess the influence of physician decision-making on patient prognosis.

Main Methods:

• Analysis of data from 5 large, randomized clinical trials comparing PCI and CABG.
• Long-term follow-up data, including mortality and reintervention rates.
• Subgroup analysis for diabetic patients.

Main Results:

• Overall clinical outcomes and risks are equivalent between PCI and CABG.
• PCI is associated with a significantly higher rate of reinterventions compared to CABG.
• Long-term follow-up in the Bypass Angioplasty Revascularization Investigation (BARI) trial showed lower mortality for diabetic patients treated with CABG.
• Physician's therapeutic decision-making significantly impacted patient prognosis.

Conclusions:

• PCI and CABG provide equivalent clinical outcomes for multivessel coronary disease.
• CABG may offer a survival benefit for diabetic patients.
• Higher reintervention rates after PCI necessitate careful patient selection and ongoing research into new devices like stents.