CABG question

[slick177]

MSII needs help with a question

Coronary artery bypass surgery has NOT been shown to improve survival in which group of patients?

a. patients with two vessel disease without stenosis of the proximal left anterior descending artery
b. patients with three vessel disease plus a LV ejection fraction of less than 50%
c. patients with three vessel disease plus severe angina
d. patients with left main coronary artery disease
e. patient with two vessel disease with stenosis of the proximal left anterior descending artery and a left ventricular ejection fraction of less than 50%

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[hemoglobin]

I would say (A).

 

[dude44]

Hgb is right-

 

[Soul]

Option (a) is not an indication for CABG, those guys will be benefited from PCI.

 

[P Diddy]

Option (a) is not an indication for CABG, those guys will be benefited from PCI.

Options A, B, C, D and E will all benefit from PCI. Current data suggests that Option D will benefit more from CABG than PCI. For the others (aside from increased revascularization in the PCI groups), it's a wash (unless they're diabetic, then PCI < CABG. at least until FREEDOM comes out).

p diddy

 

[cowbell]

Options A, B, C, D and E will all benefit from PCI. Current data suggests that Option D will benefit more from CABG than PCI. For the others (aside from increased revascularization in the PCI groups), it's a wash (unless they're diabetic, then PCI < CABG. at least until FREEDOM comes out).

p diddy

The OP was referring to a board-type question that referred to SURVIVAL and not relief from angina. All the subsequent respondents were correct except for you.

Unless, you can show me the data (or ACC/AHA guideline) that CABG or PCI increases SURVIVAL in two vessel CAD (not involving prox LAD) in the absence of ACS.

 

[P Diddy]

The OP was referring to a board-type question that referred to SURVIVAL and not relief from angina. All the subsequent respondents were correct except for you.

Unless, you can show me the data (or ACC/AHA guideline) that CABG or PCI increases SURVIVAL in two vessel CAD (not involving prox LAD) in the absence of ACS.

i wasn't responding to the OP's question directly but to the assertion above my post which implied that the other choices would not benefit from PCI.

I agree with you that there is scant data that mortality outcomes improve with PCI or CABG for stable, less than 3V disease.

p diddy

 

[Soul]

i wasn't responding to the OP's question directly but to the assertion above my post which implied that the other choices would not benefit from PCI.

I never said other choices would not benefit from PCI, I said that the patients group in option 'a' would be benefited from PCI and CABG is not indicated for those pts.

 

[cowbell]

Options A, B, C, D and E will all benefit from PCI. Current data suggests that Option D will benefit more from CABG than PCI. For the others (aside from increased revascularization in the PCI groups), it's a wash (unless they're diabetic, then PCI < CABG. at least until FREEDOM comes out).

p diddy

i wasn't responding to the OP's question directly but to the assertion above my post which implied that the other choices would not benefit from PCI.

I agree with you that there is scant data that mortality outcomes improve with PCI or CABG for stable, less than 3V disease.

p diddy

I can see where you are coming from. Granted, most randomized controlled studies comparing PCI versus CABG for multi-vessel CAD do not show a significant difference in major adverse cardiac endpoints, except in the diabetic population (and increased repeat procedures in PCI arms). However, I disagree with you that PCI versus CABG is a "wash" for multi-vessel or left main CAD, +/- impared LVEF. I think in greater than half of these clinical presentations, there is a distinct advantage of one over the other based upon patient preference, specific coronary anatomy (and type of lesions), co-morbidities, condition of aortic root, and capabilities/experience of the specific center.

And to the OP, just remember in these board-type questions, the guidelines answer is the "correct" answer. There should be no ambiguities in these questions (unlike in real life clinical scenarios). The data for this specific question is based upon the VA Co-op, CASS, and European CSS studies (oldies but goodies).