Percutaneous Coronary Revascularization

Q: What is the clinical evidence from this study?

Study design: Review. Population: Coronary artery disease. Intervention: Percutaneous coronary intervention vs. Coronary artery bypass graft surgery.

Patrick W. Serruys; Masafumi Ono; Scot Garg; Hironori Hara; Hideyuki Kawashima; Giulio Pompilio; Daniele Andreini; David R. Holmes; Yoshinobu Onuma; Spencer B. King

doi:10.1016/j.jacc.2021.05.024

July 1, 2021Journal of the American College of CardiologyOpen Access

Percutaneous Coronary Revascularization

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Key result

PCI offers an acceptable alternative to CABG for advanced CAD requiring individualized precision medicine.

Why the study?

Trialists have struggled to establish the respective roles for PCI and CABG, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease.

Key Points

To review the evolving clinical roles and comparative long-term outcomes of percutaneous coronary intervention versus coronary artery bypass graft surgery in complex coronary artery disease.
Synthesized evidence from pivotal randomized clinical trials and meta-analyses comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft (CABG) surgery.
Evaluated patient populations with multivessel disease (MVD) and unprotected left main coronary artery disease (LMCAD), incorporating up to 10 years of clinical follow-up.
Assessed trial designs using bare-metal stents (BMS), first-generation drug-eluting stents (DES), and newer-generation DES, alongside risk stratification tools including the SYNTAX score and EuroSCORE.
In the PRECOMBAT trial of LMCAD (N=600), MACCE rates for PCI versus CABG were 8.7% vs 6.7% at 1 year (Pnoninferiority=0.01), 17.5% vs 14.3% at 5 years (Psuperiority=0.26), and 29.8% vs 24.7% at 10 years (HR: 1.25; 95% CI: 0.93-1.69).
In the FREEDOM trial of diabetic patients with multivessel disease, 5-year primary composite rates of death, MI, and stroke were 26.6% with PCI versus 18.7% with CABG (P=0.005), with all-cause mortality at 16.3% vs 10.9% (P=0.049).
In the SYNTAXES study at 10 years, all-cause mortality did not significantly differ between PCI and CABG among women (33.0% vs 32.5%; log-rank p=0.601) or patients with diabetes (36.4% vs 34.5%; log-rank p=0.551).

PICO

P

Population

A historical review of clinical trials and meta-analyses comparing percutaneous coronary intervention and coronary artery bypass graft surgery in patients with advanced coronary artery disease.

I

Intervention / Comparator

Percutaneous coronary intervention vs Coronary artery bypass graft surgery

Limitations

Further studies are needed to clarify the optimum approach to selection of one revascularization strategy over another for individual patients with coronary artery disease.

Implication

Clinical review demonstrates therapeutic efficacy of catheter-based interventions in coronary artery disease, highlighting techniques to restore myocardial perfusion.

Abstract

Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: "Which treatment strategy is better and for which patient?"

Discussion

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Cite This Study

Serruys et al. (2021) conducted a review in Coronary artery disease. Percutaneous coronary intervention vs. Coronary artery bypass graft surgery was evaluated. Percutaneous coronary intervention has evolved into an acceptable alternative to coronary artery bypass grafting for advanced coronary artery disease, though optimal selection requires individualized precision medicine.

synapsesocial.com/papers/6a959b56e09b73fec4b2a085 https://doi.org/10.1016/j.jacc.2021.05.024

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Percutaneous Coronary Revascularization

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Percutaneous Coronary Revascularization

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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