Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery

Bravata, Dena M; Gienger, Allison; McDonald, Kathryn M; Sundaram, Vandana; Pérez, Marco; Varghese, Robin; Kapoor, John R; Ardehali, Reza; Owens, Douglas K; Hlatky, Mark A.

doi:10.7326/0003-4819-147-10-200711200-00185

Cited by 285 publications

(198 citation statements)

References 129 publications

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“…The meta-analysis showed that the rate of major adverse cardiac or cerebrovascular events was lower with CABG than with PCI and that patients who underwent CABG had fewer repeat revascularization procedures than patients who underwent PCI. After 5 years of follow-up, the meta-analysis did not show any significant differences in rates of survival between the CABG and PCI groups, 34 although other studies have shown differences in mortality. [10][11][12] Second, the use of medication differed between the groups in our study, reflecting variations in standard care of patients between the two treatment groups.…”

mentioning

confidence: 95%

“…The risk of repeat revascularization after PCI needs to be balanced against the invasiveness of CABG and the risk of stroke, as previously reported in a meta-analysis of 23 studies comparing CABG and PCI, in which procedure-related strokes were found to be more common after CABG (in 1.2% of patients, vs. 0.6% of those undergoing PCI; P<0.001), without a concomitant decrease in survival. 34 Recently, concern has been expressed about the possibility of an increased risk of late stent thrombosis with drug-eluting stents. In the SYNTAX trial, most cases of stent thrombosis occurred within 30 days after the procedure, and the 12-month rate of stent thrombosis in the PCI group was similar to the rate of symptomatic graft occlusion in the CABG group.…”

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confidence: 99%

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Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Serruys¹,

et al. 2009

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confidence: 95%

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confidence: 99%

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Serruys¹,

et al. 2009

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“…Apesar da conhecida superioridade dos stents farmacológicos em relação aos stents convencionais em reduzir a necessidade de novas revascularizações da lesão-alvo, não foram utilizados tais stents neste estudo devido a sua não incorporação pelo SUS. Quando comparados a utilização dos stents convencionais e a cirurgia de revascularização miocárdica para tratamento da doença coronariana multiarterial, observou-se em metanálise recente, incluindo 23 ensaios randomizados com mais de 10.000 pacientes, que ao final de 5 anos de seguimento clínico não foi observada diferença significativa na mortalidade entre as duas terapêuticas, mas a cirúrgica forneceu maior durabilidade tardia da revascularização, com taxas menores de novos 16 18 . Quando a intervenção coronariana em multiarteriais foi realizada com stents farmacológicos e comparada aos resultados cirúrgicos, ocorreu uma grande redução da taxa de revascularização e, dependendo da complexidade das lesões, ainda mais favorável para a cirurgia 7 .…”

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Análise dos valores SUS para a revascularização miocárdica percutânea completa em multiarteriais

Meireles¹,

Sumita²,

Forte³

et al. 2010

Arq. Bras. Cardiol.

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ResumoFundamento: O Sistema Único de Saúde (SUS) estabelece que a angioplastia coronariana com o implante de duplo stent não deve exceder 20% das angioplastias, resultando na necessidade de escalonar a maioria dos procedimentos nos pacientes com doença multiarterial.Objetivo: O objetivo do presente estudo foi avaliar os valores remunerados pelo SUS para a obtenção da revascularização miocárdica percutânea completa em pacientes do SUS com doença multiarterial relacionados ao número de procedimentos necessários e de stents implantados. Métodos

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“…Balanced against these benefits is the observation that patients with DM who undergo revascularization experience less improvement in anginal symptoms compared to nondiabetics. 9 The BARI 2D trial was the first large randomized trial to enroll exclusively diabetic patients with CAD and stable angina. 10 This study demonstrated that an initial revascularization strategy plus optimal medical therapy yielded outcomes similar to optimal medical therapy with deferral of revascularization.…”

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confidence: 99%

Percutaneous Coronary Intervention in Patients With Diabetes

Armstrong

Waltenberger

Rogers

2014

J Diabetes Sci Technol

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Over 170 million people worldwide have diabetes mellitus (DM), with an increasing proportion of these patients diagnosed in the developing world.1 Despite medical advances in prevention of coronary artery disease (CAD), the rising prevalence of DM threatens to increase the global burden of cardiovascular disease in the next 2 decades.2 Currently, patients with DM compose 25% to 30% of all patients undergoing coronary artery revascularization.3 Up to 60% of patients presenting with acute myocardial infarction may also have previously unrecognized diabetes. [4][5][6] The increasing recognition that DM is associated with adverse outcomes after coronary revascularization has led to the development of newer stent technologies and pharmacotherapies that may be differentially utilized in diabetic patients.This article reviews revascularization strategies, the current use of percutaneous coronary intervention (PCI), new developments in stent technology, and the importance of medical therapy after PCI among patients with DM. Timing of Revascularization and Revascularization StrategyPatients with DM have more diffuse and complex CAD than nondiabetic patients. 7 Revascularization of high-risk anatomy including proximal LAD stenosis is also associated with mortality benefit among patients with DM.8 Some have therefore advocated performing revascularization in diabetic patients regardless of symptoms. Balanced against these benefits is the observation that patients with DM who undergo revascularization experience less improvement in anginal symptoms compared to nondiabetics. 9 The BARI 2D trial was the first large randomized trial to enroll exclusively diabetic patients with CAD and stable angina. 10 This study demonstrated that an initial revascularization strategy plus optimal medical therapy yielded outcomes similar to optimal medical therapy with deferral of revascularization. Even with a deferred strategy, however, 38% of patients required revascularization during a 5-year follow-up period. 11Importantly, patients with left main coronary artery stenosis ≥ 50% or uncontrolled angina were excluded from BARI 2D and should undergo prompt revascularization. AbstractPatients with diabetes and coronary artery disease represent a challenging and growing subset of the population. Although surgical revascularization is the preferred treatment for patients with diabetes and multivessel coronary artery disease with stable angina, a significant proportion of diabetic patients undergo percutaneous revascularization due to comorbidities, presence of single-vessel disease, or presentation with myocardial infarction. The development of drug-eluting stents has significantly improved the results of percutaneous revascularization among diabetic patients, but a number of challenges remain, including higher rates of restenosis and stent thrombosis among diabetic patients. With current technologies, the outcomes of diabetic patients treated with noninsulin agents have approached that of nondiabetic patients. In comparison, patients with diab...

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Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery

Abstract: Compared with PCI, CABG was more effective in relieving angina and led to fewer repeated revascularizations but had a higher risk for procedural stroke. Survival to 10 years was similar for both procedures.

Cited by 285 publications

References 129 publications

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Análise dos valores SUS para a revascularização miocárdica percutânea completa em multiarteriais

Percutaneous Coronary Intervention in Patients With Diabetes

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