Cardiac Bypass Surgery and Percutaneous Coronary Intervention (PCI)
- CABG and PCI
- PCI- For Stable Coronary Artery Disease
- PCI- For Unstable Coronary Artery Disease
- PCI vs CABG for multi-vessel disease
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Notes from the European Society of Cardiology Meeting, 2008
Stable Coronary Artery Disease- COURAGE
Data was presented data showing that the PCI group also had optimal medical
therapy ie there were no significant differences in medical treatment that could have accounted for lack of benefit of PCI over initial medical therapy. There was a high rate of adherence to treatment.
One needs to treat 12 patients with PCI and of these one will have a significant improvement of quality of life at one year post-procedure. However, the benefits of PCI in terms of quality of life decreases with time and for one person to have a significant improvement of life after three years there is a need to treat 50 patients with PCI. This should make us question the cost-effectiveness of routine PCI therapy for all.
Of note is that in the COURAGE trial only 1% crossed over to PCI in the first year. The COURAGE
patients were at moderate or high risk. The trial excluded those with positive
ETT in the first stage of the Bruce Protocol.
Data was also presented on decreasing rates of death from CAD over the
years and data that supports the supposition that only <5% of this decrease was due to use of PCI
and surgery- this evidence was used to also raise the question of the cost-effectiveness of surgery.
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