Myocardial Revascularization
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Coronary anatomy
Myocardial Revascularization
Coronary artery disease (CAD) can be managed by optimal medical therapy (OMT) and/or mechanical revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In the setting of evolving drugs, techniques and evidence regarding these therapeutic options, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have published [1, 2] a guidelines document, establishing indications for revascularization and the appropriate modalities of achieving it. This editorial lists the essential messages of these Joint ESC/EACTS Guidelines on Myocardial Revascularization.
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Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG.We linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias.Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group; risk ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%; risk ratio, 0.79; 95% CI, 0.76 to 0.82). Similar results were noted in multiple subgroups and with the use of several different analytic methods. Residual confounding was assessed by means of a sensitivity analysis.In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI. (Funded by the National Heart, Lung, and Blood Institute.).
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Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have undergone substantial technological advances, and revascularization is an established therapeutic option in the treatment of coronary artery disease (CAD). Here we focus on optimization of decision making in revascularization strategies, as is being addressed in recent large clinical trials and the guidelines issued by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Clinical Pharmacology & Therapeutics (2011) 90 4, 630–633. doi:10.1038/clpt.2011.162
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Objectives: With rapidly increasing numbers of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) constantly declined. Among other reasons, exclusion of surgeons from decision-making of initial treatment strategy has been attributed to this development. Nowadays about 15% of CABG patients had previous PCI, however, the number of patients necessitating CABG in the course after PCI is uncertain. We analyzed incidence of CABG within 10 years after first PCI with special regard to multidisciplinary conference guided treatment.
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Coronary artery bypass grafting (CABG) and Percutaneous coronary intervention (PCI) revascularization strategies have undergone significant advancements in recent years, creating the need to reexamine data from clinical studies and critically scrutinize existing guidelines in order to determine the optimal care for each individual patient.
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