Document Detail


Comparison of mid-term outcome in patients with three-vessel and/or left main disease undergoing percutaneous coronary intervention and coronary artery bypass graft surgery.
MedLine Citation:
PMID:  19896388     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To compare the outcome including death, myocardial infarction, stroke, recurrent angina and need for re-intervention in patients with multivessel disease undergoing percutaneous intervention (PCI) or coronary artery bypass graft surgery (CABG). A 'real-world' evaluation of current practice in UK is lacking.
METHODS: A retrospective and ongoing analysis of consecutive patients with three-vessel disease and/or left main stem undergoing PCI or CABG between September 2005 and December 2006 was carried out. In-hospital outcome and outcome measures at 6 and 12 months, including death, myocardial infarction, cerebrovascular events, recurrent angina and re-intervention were recorded. Adjustment for each baseline variable was made separately.
RESULTS: A total of 646 patients were identified: 313 PCI and 333 CABG. At 6 months, data were available for 88% of PCI and 96% of CABG patients (P=0.07) and at 12 months for 90% of PCI and 97% of CABG patients. Death, myocardial infarction or stroke were less frequent in CABG than in PCI patients (odds ratio (OR)=0.40, 95% confidence interval (CI)=0.21-0.85, P=0.01). Death, myocardial infarction, stroke, re-intervention and recurrent angina were also less frequent in CABG than in PCI patients (OR=0.16, 95% CI=0.10-0.26, P<0.001). The effect remained significant after all adjustments for baseline variables. Similar results were found at 12 months.
CONCLUSIONS: CABG is associated with improved major adverse cardiovascular and cerebrovascular events in patients with three-vessel and/or left main stem disease compared with PCI at 6 and 12 months. Our results indicate that, in the era of exponential growth of stents in patients with three-vessel disease, outcome will improve if patients are discussed in multidisciplinary meetings where the best treatment option can be chosen.
Authors:
Evgenia Biryukova; Frances M Williams; Oswaldo Valencia; Juan Carlos Kaski; Martin Bland; Marjan Jahangiri
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-11-05
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-23     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  905-11     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Departments of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angina Pectoris / prevention & control
Angioplasty, Balloon, Coronary* / adverse effects
Coronary Artery Bypass* / adverse effects
Coronary Artery Disease / pathology,  surgery,  therapy*
Epidemiologic Methods
Female
Humans
Male
Middle Aged
Myocardial Infarction / etiology
Recurrence
Stroke / etiology
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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