Our Summary

This research study compared two different treatments for patients with severe heart disease affecting multiple blood vessels. The treatments were percutaneous coronary intervention (PCI) with a drug-eluting stent (a procedure where a small tube is inserted to keep the artery open and slowly releases a drug to prevent the artery from getting blocked again) and coronary artery bypass grafting (CABG, a type of surgery that improves blood flow to the heart).

The study included 2,193 patients who had either the PCI with a specific type of stent (sirolimus-eluting) or the CABG surgery. After five years, they found that there was no significant difference in the combined outcome of death from any cause, heart attack, or stroke between the two groups. The risk of death and stroke was also similar for both groups.

However, they did find that the group who had the PCI procedure had a higher risk of needing another procedure to improve blood flow to the heart. They also found that the risk of heart attack, hospitalization for heart failure, and major bleeding was significantly different between the two groups.

In conclusion, for patients with severe heart disease affecting multiple blood vessels, the PCI procedure with a sirolimus-eluting stent had similar long-term outcomes to the CABG surgery, but with a higher risk of needing another procedure to improve blood flow to the heart.

FAQs

  1. What are the two treatments compared in this research study for severe heart disease affecting multiple blood vessels?
  2. How did the long-term outcomes of the PCI procedure with a sirolimus-eluting stent compare to the CABG surgery?
  3. Did the study find any significant differences in risk between the two treatments for severe heart disease?

Doctor’s Tip

A helpful tip a doctor might tell a patient about CABG is that it is a highly effective treatment for severe heart disease affecting multiple blood vessels. It can improve blood flow to the heart and reduce the risk of heart attack, stroke, and death. Patients should be aware of the potential risks and benefits of CABG compared to other treatment options, such as PCI with a drug-eluting stent, and discuss these options with their healthcare provider to make an informed decision about their care.

Suitable For

Patients who are typically recommended for CABG include those with severe heart disease affecting multiple blood vessels, particularly those who may not be good candidates for PCI or who have failed previous PCI procedures. These patients may have complex coronary artery disease, diabetes, left main coronary artery disease, or reduced heart function. Additionally, patients with severe symptoms such as chest pain, shortness of breath, or angina that is not controlled with medication may also be recommended for CABG. It is important for patients to discuss their individual risk factors and treatment options with their healthcare provider to determine the best course of action for their specific condition.

Timeline

Before CABG:

  1. Patient is diagnosed with severe heart disease affecting multiple blood vessels.
  2. Patient undergoes various tests and evaluations to determine the best treatment option.
  3. Patient discusses treatment options with their healthcare provider and decides to undergo CABG surgery.

After CABG:

  1. Patient is admitted to the hospital for the surgery.
  2. Surgery is performed to improve blood flow to the heart by bypassing blocked or narrowed arteries.
  3. Patient recovers in the hospital for a few days to a week.
  4. Patient may undergo cardiac rehabilitation to help with recovery and improve heart health.
  5. Patient follows up with their healthcare provider regularly to monitor their heart health and make any necessary adjustments to their treatment plan.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing CABG surgery compared to PCI with a drug-eluting stent?
  2. How long is the recovery time for CABG surgery compared to PCI?
  3. Will I need to take any medications after undergoing CABG surgery or PCI?
  4. What lifestyle changes will I need to make after undergoing CABG surgery or PCI?
  5. How often will I need to follow up with you after undergoing CABG surgery or PCI?
  6. Are there any specific factors about my health or condition that make one treatment option more suitable for me than the other?
  7. What is the long-term success rate of CABG surgery compared to PCI with a drug-eluting stent?
  8. What are the chances of needing another procedure in the future if I choose to undergo PCI with a drug-eluting stent?
  9. How will the cost of CABG surgery compare to PCI with a drug-eluting stent, and will my insurance cover either procedure?
  10. Are there any alternative treatment options for my severe heart disease that I should consider before making a decision between CABG surgery and PCI with a drug-eluting stent?

Reference

Authors: Watanabe H, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Tazaki J, Watanabe H, Natsuaki M, Minatoya K, Hanyu M, Komiya T, Kimura T; CREDO-Kyoto PCI/CABG registry/cohort-2 investigators. Journal: Catheter Cardiovasc Interv. 2020 Jul;96(1):42-51. doi: 10.1002/ccd.28420. Epub 2019 Aug 7. PMID: 31389659