PCI vs CABG Debate

[3magin8]

Hi folks,

So I would like to hear all your opinions on PCI versus CABG for treatment of coronary vessel disease.

The results of the SYNTAX trial showed that both treatment had similar mortality rates. PCI required higher revascularization rates as CABG had a higher stroke rates.

Personally, I think PCI is the way to go. The need revascularize is nothing compared to the increased costs and risk of morbidity associated with CABG--and PCI is also much much more patient friendly.

What do you guys think?

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[dragonfly99]

It depends on a lot of things - patient characteristics, where the blockages are (which arteries, how extensive, etc.), etc. There are cases where CABG is clearly superior, which is why it is still around. There are cases where PCI is clearly superior. There are cases where you could reasonably lobby for either of the two. There are even "hybrid" cath labs or OR's now where the surgeons and interventional cardiologists can work together.

 

[Myostatin]

As you point out, most of the big trials in this area use big combined endpoints, which makes PCI look worse secondary to repeat revascularization measures. Also, its a constantly changing target for state of the art PCI as technology changes faster than trials can keep up, but as dragon said, there are still clearly cases where CABG is superior, however the majority of the time I think PCI is an equivalent or better option.

 

[Myostatin]

... also, the dark secret of "pump brain" is a variable not included in trials... many people post CP bypass don't have a stroke exactly, but just aren't cognitively the same afterwards....

 

[sevo85288]

depends on the lesion, presence of DM, age, sex, ethnicity, other co-morbiditirs. It is not a simple question.

What percent of PCI pt;s eventually need a CABG? I will let you look that one up.

 

[copacetic]

what you ask is a very complicated question. In general i would agree with what has been said. I was at the recent AHA meeting, and sat in on some forums regarding this very issue. some things to note/add to what has already been said:

1) BOTH PCI and CABG are here to stay. Some things are better done using PCI and others CABG
2) many of the trials that are done evaluating PCI are normally out of date by the time the data are published due to the rapid advancements made in the field
3) But procedures have similar efficacies (in general)....however...one must take into account the patient subset when evaluating the best procedure to use...
4) related to the point above...Its becoming clear that PCI seems to offer the best outcomes for younger populations (those under 60 or so) while CABG and surgical interventions appear to correlate with better outcomes in older patient populations why is this? see # 5
5) Most of the studies evaluating the efficacy of PCI have been done in relatively younger patient population subsets. The results may be biased across the entire spectrum of patients...though there remains no question as to the efficacy of the procedure
6) The question of whats BETTER is kind of besides the point if we ask generally. I cannot stress enough that we have to look at the patient subset, and the individual patient
7) I fully believe that in the future a more collaborative atmosphere will develop between CT surgeons and IC. and BOTH fields will get better at what they do.