Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes

Abstract

CABG is associated with reduced rates of major adverse cardiac events, mostly driven by reduced repeat revascularisation. However, the RCT data are limited by follow-up, unrepresentative samples and rapid development of both surgical techniques and stenting. Research on real-world patient population or patient level data meta-analyses may identify risk factors and groupings who may benefit most from one strategy over the other.

Improving long-term outcomes following coronary artery bypass graft or percutaneous coronary revascularisation: results from a large, population-based cohort with first intervention 1995-2004

“…Previous reports indicated fivefold1 to 10-fold9 11 13 excess requirement for further revascularisation after PCI compared to CABG. As recently as 1997–9, a 17-fold excess was evident after elective or emergency index procedures within the Scottish registry database 11.…”

“…Despite their methodological superiority, clinical trials recruit highly selected populations, often with limited follow-up and small numbers of observed end-points. This is exemplified by a recent meta-analysis,1 which although reporting no statistical difference in one-year mortality between PCI (with stent) and CABG (0.8% and 2.4%, respectively), did so on the basis of only 75 deaths. An earlier meta-analysis, covering a period largely predating the stent usage, indicated one-year case-fatality of 2.9% and 4.4% after PCI and CABG, respectively 10.…”

Outcome of stable angina in a working population: the burden of sickness absence

“…Fatal and non-fatal coronary events are becoming rarer prognostic outcomes, with annual risks less than 3% in consecutive patient registries [4], and even lower in trials [5]. However, many individuals with angina remain symptomatic despite modern treatment [6,7], and therefore there is a growing need for outcome event measures that are commonly experienced, objectively observed and reflect global impairments of functioning. Medically certified spells of sickness absence may offer such an outcome measure, reflecting the physical, psychological and social functioning of an individual with respect to their work role.…”

Description of a methodological approach to verify the outcome-optimization of tailored therapeutic choices and test application to PCI vs. CABG.

“…In the case of severe Coronary Artery Disease (CAD) (left main or multivessel involvement) -the scientific evidence [1][2][3][4][5][6][7][8][9] supporting the interventional choice between Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) is inconclusive. Uncertainty surrounds not only the 'best' technique in absolute terms (i.e.…”