Our Summary

This research paper discusses a study that compared two different treatments for patients with multi-vessel heart disease: percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) and coronary artery bypass grafting (CABG). The study included 2,464 patients, of which 1,565 were treated with PCI and 899 with CABG.

The results showed that patients who underwent PCI were older and more frail, but their heart disease was less complex. Over a 5-year period, there wasn’t a significant difference in death, heart attack, or stroke rates between the two groups. However, after adjusting for various factors, patients who underwent PCI had a slightly higher risk of experiencing a major cardiovascular event compared to those who had CABG.

In simpler terms, the study suggests that for patients with multi-vessel heart disease, CABG might be a safer long-term treatment option than PCI.

FAQs

  1. What were the two treatments compared in this study for patients with multi-vessel heart disease?
  2. Was there a significant difference in death, heart attack, or stroke rates between patients who underwent PCI and those who underwent CABG?
  3. According to the study, which treatment option might be safer in the long term for patients with multi-vessel heart disease?

Doctor’s Tip

One helpful tip a doctor might give a patient about CABG is that it is a more durable and long-lasting treatment option compared to PCI for multi-vessel heart disease. It may be worth considering CABG for better long-term outcomes and reduced risk of major cardiovascular events.

Suitable For

Patients who are typically recommended CABG are those with complex multi-vessel heart disease, especially those who are younger and less frail. CABG is often recommended for patients with severe blockages in multiple coronary arteries, left main coronary artery disease, or those who have diabetes. Additionally, patients who have already had a stent placed that has become blocked or who have failed previous PCI procedures may also be recommended for CABG.

Overall, CABG is typically recommended for patients who have more complex and severe heart disease, as it is often considered a more durable and effective treatment option in these cases compared to PCI. However, the decision to undergo CABG or PCI ultimately depends on the individual patient’s specific medical history, risk factors, and preferences, and should be made in consultation with a cardiologist or cardiac surgeon.

Timeline

Before CABG:

  1. Patient undergoes diagnostic tests to determine the extent and severity of their heart disease.
  2. Patient may undergo medications and lifestyle changes to manage their symptoms and risk factors.
  3. Patient and their healthcare team decide on the best treatment option, which may include CABG if the heart disease is severe and involves multiple blockages in the coronary arteries.

After CABG:

  1. Patient undergoes surgery to have their blocked coronary arteries bypassed using a healthy blood vessel from another part of the body.
  2. Patient is closely monitored in the hospital for any complications and to ensure proper healing.
  3. Patient undergoes cardiac rehabilitation to help them recover and regain strength after surgery.
  4. Patient continues to follow up with their healthcare team for long-term management of their heart disease and to monitor for any potential complications or the need for further interventions.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing coronary artery bypass grafting (CABG) compared to other treatment options such as percutaneous coronary intervention (PCI) using drug-eluting stents?

  2. How does CABG compare to PCI in terms of long-term outcomes, such as mortality rates, risk of heart attack, and risk of stroke?

  3. What factors should be considered when deciding between CABG and PCI for treating multi-vessel heart disease?

  4. What is the recovery process like after undergoing CABG surgery, and how does it compare to the recovery process after PCI?

  5. Are there any specific lifestyle changes or medications that I should be aware of after undergoing CABG?

  6. Are there any potential complications or side effects associated with CABG surgery that I should be aware of?

  7. How frequently will I need to follow up with my doctor after undergoing CABG surgery, and what monitoring will be necessary to ensure the success of the procedure?

  8. Are there any alternative treatment options for multi-vessel heart disease that I should consider before deciding on CABG?

Reference

Authors: Watanabe H, Yamamoto K, Shiomi H, Morimoto T, Kato E, Matsumura Y, Nakatsuma K, Takeji Y, Yaku H, Yamamoto E, Yamashita Y, Yoshikawa Y, Fuki M, Yamaji K, Ehara N, Sakamoto H, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T; On behalf the CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators. Journal: PLoS One. 2022 Sep 29;17(9):e0267906. doi: 10.1371/journal.pone.0267906. eCollection 2022. PMID: 36174029