Bypass surgery superior to angioplasty with stenting for advanced CAD

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Patients with multivessel coronary artery disease fare better when they receive coronary artery bypass graft surgery CABG - (substituting a healthy artery or vein from the body for the blocked coronary artery and requiring open-heart surgery with bypass), as opposed to percutaneous cardiac interventions PCI - (a non-surgical procedure involving stenting of the coronary arteries via angioplasty, passing a catheter through an artery to the heart). PCI does not require opening the chest and putting the patient on heart-lung bypass.

A new report from the annual meeting of the Society of Thoracic Surgeons shows that CABG cut the risk of the combined outcomes of death, heart attack, and stroke 19 percent better than PCI over a four year period.

The study population included 86,000 patients who received CABG and 103,000 patients who received PCI. Over the course of the four year study, 21.6 percent of CABG patients experienced one of the adverse events, as opposed to 26.7 percent of PCI patients. Heart attack risk was reduced by 51 percent in CABG patients. Although there were more strokes reported in CABG patients 43 percent higher than PCI patients, the increased risk was only present in the few days following surgery. And overall survival for CABG patients was 21 percent higher than PCI patients.

Dr. Timothy Gardner, medical director of Christiana s Care Center for Heart and Vascular Health in Newark, Delaware, says It s an observational study so we don t have a lot of patient-specific factors that went into why one person went to surgery or why another person didn t. He also adds that although the registries appear to show a benefit in survival for the surgical approach, the final decision of whether a patient needs coronary artery bypass grafting or percutaneous cardiovascular intervention and stenting remains part of the art of medicine.

I believe this study will be influential among cardio-thoracic surgeons and cardiologists when deciding on the best approach for patients with advanced CAD who need coronary artery surgery, said ACSH s Dr. Gilbert Ross. Still, this observational study is not definitive, as noted by the author, but will be taken into account henceforth, at least until a randomized, prospective study is done.