Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease

Serruys, P.W.; Unger, Felix; Sousa, Francisca Isabelle da Silva e

doi:10.1016/s1062-1458(01)00418-4

Cited by 208 publications

(306 citation statements)

References 26 publications

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“…5,15 In patients who received stents for multivessel CAD, Serruys and colleagues observed that 21% still experienced angina 12 months later. 12 Similar results were seen in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study, where 34% of patients who received PCI still had angina 1 year later. 14 Resource utilization among patients with stable angina and CAD is substantial.…”

Section: Introductionsupporting

confidence: 69%

Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

Boden

Finn

Patel

et al. 2012

Clinical Cardiology

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The goals of optimal medical therapy in patients with stable angina pectoris are to reduce the risk of cardiovascular mortality and future cardiovascular events, improve exercise capacity, and enhance quality of life. Whereas myocardial revascularization is frequently employed in the management of patients with stable angina, a variety of pharmacologic interventions are recommended as part of optimal medical management. The use of short‐ and rapidly‐acting nitrates (eg, sublingual nitroglycerin spray and tablets) is at the core of the therapeutic armamentarium and should be integrated into optimal medical therapy for stable angina along with exercise therapy. The potential clinical implications from these observations are that prophylactic sublingual nitrates, when combined with cardiac rehabilitation, may allow the patient with angina to exercise to a greater functional capacity than without sublingual nitrates. Clin. Cardiol. 2012 DOI: 10.1002/clc.21993William E. Boden: Advisory Board for Arbor Pharmaceuticals. Aloke V. Finn: Sponsored research agreement with Medtronic Vascular; Scientific Advisory Board for Medtronic Vascular; Advisory Board for Arbor Pharmaceuticals. Dharmesh Patel: Speakers Bureau for Novartis, Arbor Pharmaceuticals, Medtronic, Takeda Pharmaceuticals, Abbott, St Jude's Medical, Cleveland Heart Lab, Boston Heart Lab, Forrest Pharmaceuticals, Boehringer Ingelheim, and Jansen & Jansen. W. Frank Peacock: Advisory Board for Abbott, Alere, Arbor Pharmaceuticals, Lilly, and The Medicines Co; Received research grants from Alere, Brahms Comprehensive Research Associates, Electrocore, Novartis, The Medicines Co; Speakers Bureau for Abbott, Alere, and Electrocore; Ownership interest in EKR, Emergencies in Medicine, and Vital Sensors. Udho Thadani: Received consultation fee from Arbor Pharmaceuticals for interpretation of the study data and for writing this manuscript; Advisory Board for Arbor Pharmaceuticals; Consultant for Gilead Sciences, Astra Zeneca, Pfizer, Merck, Bristol‐Myers Squibb, Bayer, Forest Laboratories, and Servier; Speaker's program for Eli Lilly and Daiichi‐Sankyo and Gilead Sciences. Franklin H. Zimmerman: Advisory Board for Arbor Pharmaceuticals; Speakers Bureau for Boerhinger‐Ingelheim.**At the time this manuscript was written, Dr Peacock's affiliation was: Department of Emergency Medicine, The Cleveland Clinic, Cleveland, Ohio.

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Section: Introductionsupporting

confidence: 69%

Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

Boden

Finn

Patel

et al. 2012

Clinical Cardiology

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“…PCI studies have defined CR to include arteries with diameter greater than 1.5 [63], 2.0 [64], 2.25 [65], or 2.75 mm [66] with >50 or >70% stenoses. The Writing Group suggests the following definition of CR relevant to PCI: ''revascularization of all significant arteries (as assessed by the angiographer) that threaten viable myocardium with stenoses either >70% diameter narrowing by angiography or of hemodynamic significance by stress testing or invasive assessment.''…”

Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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“…1,6, 7 Similarly, there has been concomitant growth in pharmacologic adjunctive therapy of dual antiplatelet therapy of aspirin and thienopyrides.…”

Section: Coronary Stenting Vs Cabgmentioning

confidence: 99%

Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease? - Therapeutic Strategies for 3-Vessel Coronary Artery Disease: OPCAB vs PCI (PCI-Side) -

Takayama

Hiro

Hirayama

2010

Circ J

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The optimal strategy of revascularization for multivessel disease has been controversial for a long time. In general, the initial trials 1-5 performed in the 1990s to compare PCI and CABG enrolled patients who had relatively low risk and relatively normal left ventricular function. Study participants primarily had 2-vessel disease that was deemed treatable by either method, and none had serious comorbid conditions. Those trials were performed before widespread use of coronary stents and glycoprotein IIb/IIIa inhibitor. The major findings of these trials are outlined in Table, and are all consistent and reveal no differences in overall survival or rate of Q-wave myocardial infarction (MI) in patients with multivessel disease who were randomly assigned to PCI or CABG. There was a lower rate of repeat revascularization in patients who underwent CABG than in those who had PCI.It appeared that patients with treated diabetes who underwent revascularization had lower mortality with CABG than with stenting, but this was dependent on using a left internal mammary artery graft to the left anterior descending artery. Coronary Stenting vs CABGCurrently, more than 80% of PCI procedures are performed using stents, and some clinical trials have clearly demonstrated the benefits of stents compared with plain ordinary balloon angioplasty (POBA) in regard to acute angiography results, need for emergency CABG, and restenosis rates. 1,6,7 Similarly, there has been concomitant growth in pharmacologic adjunctive therapy of dual antiplatelet therapy of aspirin and thienopyrides. In the Era of Bare Metal Stents (BMS)ARTS Trial The largest of these trials was the Arterial Revascularization Therapies Study (ARTS), 1 which included This article reviews the treatment of patients with multivessel coronary artery disease (CAD). Percutaneous coronary intervention (PCI) has been challenging coronary artery bypass grafting (CABG) as the gold standard of care for patients with multivessel disease; however, the application of PCI to these patients has been mainly limited by restenosis. Up to the beginning of the 2000s, many large-scale, randomized trials addressed this issue by comparing CABG to PCI with balloon angioplasty or bare metal stents in not only Western countries but also in Asian countries. These studies demonstrated similar rates of all-cause death and myocardial infarction in both groups, although the need for revascularization remained significantly lower in the CABG group. PCI with drugeluting stents (DES) is safe and may represent a viable alternative to CABG for selected patients with diabetes and multivessel CAD. Moreover, DES implantation under intravascular ultrasound guidance and with fractional flow reserve might have the potential to influence treatment strategy and reduce both DES thrombosis and repeat revascularization. The evolution of DES and advanced vascular imaging would mean that PCI continues to challenge CABG as treatment of choice for patients who need revascularization for a better prognosis. (Circ J 2010; 74:...

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Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease

Cited by 208 publications

References 26 publications

Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease? - Therapeutic Strategies for 3-Vessel Coronary Artery Disease: OPCAB vs PCI (PCI-Side) -

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