Our Summary

This study compared different treatments for patients with multivessel coronary artery disease, a condition where several arteries supplying blood to the heart are blocked. The treatments compared were single-arterial coronary artery bypass graft (SA-CABG), multiarterial coronary artery bypass graft (MA-CABG), and percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES).

The researchers found that MA-CABG was the most effective treatment in terms of survival rates and need for further interventions. Patients treated with BMS-PCI had worse survival rates compared to those treated with SA-CABG, particularly in the first seven years after treatment. Similarly, those treated with DES-PCI also had worse survival rates compared to MA-CABG patients, especially five and nine years after treatment.

In simple terms, the study suggests that for patients with multiple blocked arteries, the use of multiple arterial grafts (MA-CABG) is the best treatment option. This treatment improves survival rates and reduces the need for further procedures compared to the other treatments studied.

FAQs

  1. What treatments were compared in this study for patients with multivessel coronary artery disease?
  2. Which treatment was found to be the most effective for patients with multiple blocked arteries?
  3. How did the survival rates of patients treated with BMS-PCI and DES-PCI compare to those treated with SA-CABG and MA-CABG?

Doctor’s Tip

Therefore, if you are considering coronary artery bypass graft surgery (CABG) for your multivessel coronary artery disease, it is important to discuss with your doctor the possibility of using multiple arterial grafts for the best outcome. It is also important to follow your doctor’s recommendations for post-operative care and lifestyle changes to maximize the benefits of the surgery.

Suitable For

Patients who are typically recommended CABG include those with:

  1. Multivessel coronary artery disease: Patients with blockages in multiple arteries supplying blood to the heart may benefit from CABG to improve blood flow and reduce the risk of complications such as heart attacks.

  2. Severe blockages: Patients with severe blockages in their coronary arteries that cannot be effectively treated with medications or less invasive procedures like PCI may be recommended for CABG.

  3. Left main coronary artery disease: Patients with blockages in the left main coronary artery, which supplies a large portion of the heart muscle, may benefit from CABG to improve blood flow and reduce the risk of complications.

  4. Patients with diabetes: Patients with diabetes and multivessel coronary artery disease may have better outcomes with CABG compared to other treatment options due to the long-term benefits of improved blood flow to the heart.

  5. Patients with previous unsuccessful PCI: Patients who have had previous PCI procedures that have been unsuccessful or have resulted in recurrent blockages may be recommended for CABG to improve long-term outcomes.

  6. Patients with other high-risk factors: Patients with other high-risk factors for coronary artery disease, such as smoking, high cholesterol, or a family history of heart disease, may also be recommended for CABG to reduce the risk of complications and improve overall heart health.

Timeline

Before CABG:

  1. Patient undergoes diagnostic tests such as angiography to identify blockages in the coronary arteries.
  2. Patient may undergo lifestyle changes, medications, or other treatments to manage symptoms and improve heart health.
  3. If deemed necessary, patient is scheduled for CABG surgery.

After CABG:

  1. Patient undergoes CABG surgery, where a surgeon uses healthy blood vessels from other parts of the body to bypass blocked coronary arteries.
  2. Patient is monitored closely in the intensive care unit immediately after surgery.
  3. Patient may stay in the hospital for several days to recover and receive post-operative care.
  4. Patient undergoes cardiac rehabilitation to help with recovery and improve heart health.
  5. Patient may need to make long-term lifestyle changes, take medications, and attend follow-up appointments to maintain heart health and prevent future blockages.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with coronary artery bypass graft surgery (CABG)?
  2. How long is the recovery period after CABG surgery and what can I expect during the recovery process?
  3. Are there any lifestyle changes or medications I will need to take after CABG surgery?
  4. How long do the benefits of CABG surgery typically last?
  5. How will I be monitored for any potential complications or issues following CABG surgery?
  6. What is the success rate of CABG surgery for patients with multivessel coronary artery disease?
  7. How does the use of multiple arterial grafts (MA-CABG) compare to other treatment options for multivessel coronary artery disease in terms of long-term outcomes?
  8. What factors should I consider when deciding between SA-CABG, MA-CABG, and PCI with either BMS or DES for my condition?
  9. How experienced is the surgical team in performing CABG surgery, particularly with the use of multiple arterial grafts?
  10. Are there any alternative treatment options for multivessel coronary artery disease that I should consider before proceeding with CABG surgery?

Reference

Authors: Habib RH, Dimitrova KR, Badour SA, Yammine MB, El-Hage-Sleiman AK, Hoffman DM, Geller CM, Schwann TA, Tranbaugh RF. Journal: J Am Coll Cardiol. 2015 Sep 29;66(13):1417-27. doi: 10.1016/j.jacc.2015.07.060. PMID: 26403338