PCI linked to higher rates of adverse events vs. OPCAB

Feb 22nd- In patients with left main coronary artery disease, off pump coronary artery bypass grafting resulted in lower rates of major adverse cardiac and cerebrovascular events that necessitate target vessel revascularization.

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Image: CC/JHeauser

1. In patients with left main coronary artery disease, off pump coronary artery bypass grafting (CABG) resulted in lower rates of major adverse cardiac and cerebrovascular events that necessitate target vessel revascularization.

2. Rates of stroke, myocardial infarction, and death were similar in both propensity-matched groups.

Both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have undergone recent innovations that challenge findings from older studies regarding outcomes and safety. While higher target vessel revascularization in PCI patients does not differ from other historical comparisons between PCI and CABG, this institution’s experience of comparable stroke rates between the two groups is somewhat unique. This may be attributable to this hospital’s routine use of off-pump coronary artery bypass (OPCAB) and an aorta no-touch technique. Both these techniques have been reported to be beneficial for neurological outcomes, but are not standard practice in many institutions.

Click to read the study in The European Journal of Cardio-Thoracic Surgery

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Image: CC/JHeauser

1. In patients with left main coronary artery disease, off pump coronary artery bypass grafting resulted in lower rates of major adverse cardiac and cerebrovascular events that necessitate target vessel revascularization.

2. Rates of stroke, myocardial infarction, and death were similar in both propensity-matched groups.

This [retrospective] study reviewed data from 2001-2009 at the Samsung Medical Center in Seoul, South Korea, during which period 553 patients underwent OPCAB and 346 PCI. Of 159 propensity-matched pairs of patients followed for a median period of 55.9 months, patients in the PCI group had higher rates of major adverse cardiac and cerebrovascular events, driven by markedly higher rates of target-vessel revascularization and slightly increased rates of acute myocardial infarction. At 8 years, freedom from stroke, myocardial infarction, and death were similar in both propensity-matched groups.

In sum: Both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have undergone recent innovations that challenge findings from older studies regarding outcomes and safety. While higher target vessel revascularization in PCI patients does not differ from other historical comparisons between PCI and CABG, this institution’s experience of comparable stroke rates between the two groups is somewhat unique. This may be attributable to this hospital’s routine use of off-pump coronary artery bypass (OPCAB) and an aorta no-touch technique. Both these techniques have been reported to be beneficial for neurological outcomes, but are not standard practice in many institutions.

Click to read the study in The European Journal of Cardio-Thoracic Surgery

By Gina Siddiqui and Allen Ho

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