Coronary disease: Coronary bypass surgery versus percutaneous angioplasty or stent
DISEASE INTERVENTION COMPARISON RESULTS
Eur Heart J. 2005 Oct;26(20):2148-53. Epub 2005 Jun 23 Randomized Controlled Trial
IN coronary disease The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is equal Than
percutaneous coronary angioplasty
To improve long-term survival: overall mortality was similar after 13 years. Time to first re-intervention was significantly shorter in angioplasty, but frequency of re-intervention was comparable (about 70%) and also symptomatic angina or dyspnoea.
Ann Intern Med. 2007 Nov 20;147(10):703-16 Systematic Review
IN coronary disease The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is equal Than
percutaneous coronary intervention (angioplasty with/out stent)
To modify mortality at 10 years. Strokes were more common after CABG(1.2% CABG vs. 0.6% PCI) and repeated revascularization was more common after PCI (at 5 years 46.1% balloon angioplasty, 40.1% PCI with stents, and 9.8% CABG).
N Engl J Med. 2011 May 5;364(18):1718-27. Epub 2011 Apr 4 Randomized Controlled Trial, Multicenter Study
IN coronary disease, left main coronary artery stenosis The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
percutaneous stent implantation, sirolimus-eluting
To modify major cardiovascular events (death, infarction or stroke) at 2 years: 4.4% stent VS 4.7% surgery. Ischemia-driven target-vessel revascularization was more frequent in stent patients, however (9% VS 4%)
Lancet. 2009 Apr 4;373(9670):1190-7 Meta-Analysis
IN coronary disease, multivessel disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
percutaneous coronary intervention (angioplasty with/out stent)
To reduce long-term (6 years) mortality (15% bypass VS 16% PCI). Bypass may reduce mortality in patients with diabetes or aged > 65 years
N Engl J Med. 2005 May 26;352(21):2174-83 Cohorts
IN coronary disease, multivessel disease (2 or 3 vessels) The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is better Than
percutaneous stent implantation
To reduce death and revascularization at 3 years: rates?
Circulation. 2010 Sep 7;122(10):949-57 Randomized Controlled Trial
IN coronary disease, multivessel disease, stable angina The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is better Than
percutaneous coronary intervention or medical treatment alone or
To reduce at 10 years: myocardial infarction (10% CABG VS 13% PCI VS 21% medical) and need for further revascularization, but there wer no significant difference in overall mortality (75% CABG or PCI, 69% medical Tt, p NS)
N Engl J Med. 2009 Mar 5;360(10):961-72 Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel disease, or left main coronary artery disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is better Than
percutaneous coronary intervention
To reduce at 12 months major cardiovascular events (12.4% surgery VS 17.8% percutaneous), mainly reducing the need for rvascularization (5.9% surgery VS 13.5% percutaneous). But more strokes with surgery: 2.2% VS 0.6% percutaneous.
N Engl J Med. 2011 Mar 17;364(11):1016-26 Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel or left main coronary artery disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is better Than
percutaneous coronary intervention with drug-eluting stents
To modestly improve symptoms of angina (difference in score: 1.7 points) and increase number of patients free from angina at 12 months: 76% surgery VS 71% PCI