Cardiac Bypass Surgery and Percutaneous Coronary Intervention (PCI)

• CABG and PCI
  • Coronary Artery Bypass Surgery
  • Percutaneous Coronary Intervention

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• PCI- For Stable Coronary Artery Disease
  • COURAGE- PCI vs Medical Therapy
  • Routine PCI not always cost-effective.
  • From the ASEANZ 2009 meeting

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• PCI- For Unstable Coronary Artery Disease
  • To be added

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• PCI vs CABG for multi-vessel disease
  • To be added

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Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI)

PCI

PCI has been shown to improve prognosis in those:

• with unstable angina and those with non-ST segment elevation infarction.
  • There is still some uncertainty about what proportion of these patients with acute coronary syndromes should have intervention.

PCI has not been convincingly shown in randomised trials to:

• reduce the chance of myocardial infarction in patients with stable angina.
  • However, many would be inclined to consider recommending PCI to those patients with stable angina but with severe or critical lesions in the proximal left anterior descending or in other large arteries.
  • We should not be anxious if medical therapy is continued in patients have lesions in small vessels or lesions in arteries supplying small amounts of myocardium.

The aptly titled COURAGE trial published in the New England Journal of Medicine in 2007 provided randomised control trial evidence- the trial confirmed that percutaneous intervention does not reduce risk of myocardial infarction and neither does it reduce risk of death with an average followup of almost five years.