What is better for a patient with stable coronary artery disease, CABG or PCI?

  • Authors: Sokolova N.1,2,3, Golukhova E.1,2,3
  • Affiliations:
    1. ГБУЗ ТО «Областная клиническая больница», Петербургское шоссе, 105, г. Тверь, Тверская область, 170036, Российская Федерация
    2. 2 ФГБУ «НМИЦ сердечно-сосудистой хирургии им А.Н. Бакулева» МЗ РФ» Рублевское шоссе, 135, Москва, 121552, Российская Федерация
  • URL: https://vestnikramn.spr-journal.ru/jour/article/view/1232
  • DOI: https://doi.org/10.15690/vramn1232
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Abstract


Background: The main methods of treating patients with stable coronary artery disease (CAD) are myocardial revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI). These are two fundamentally different in technique and volume of surgical interventions; PCI is associated with rapid rehabilitation of the patient, and only CABG demonstrated effective in survival benefit.

Aims: comparison of the long-term results of myocardial revascularization with CABG and PCI in patients with stable CAD.

Materials and methods: The results of a prospective one-center cohort study of 369 patients with stable CAD are presented, the average age is 60.1±5.4 years. Patients were randomized into 2 groups by the «Heart Team»: CABG (n=196) and PCI (n=173). In each group, subgroups were identified depending on the severity of the coronary lesion, and the CABG group was also separately studied in according to CABG technique - beating-heart (off-pump) and with cardiopulmonary bypass (on-pump). The average follow-up was 54.3±7 months. The main outcomes of the study were major adverse cardiac and cerebral events (MACCE): death from all causes, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke and repeated coronary revascularization.

Results: Over the 5-year follow-up period, no differences were found between the CABG and PCI groups with a low complexity of coronary artery lesions (SYNTAX Score 14,2±4,8) in terms of survival, cardiac mortality, nonfatal MI and stroke, and the need for repeated myocardial revascularization. Patients with stenosis of the left main coronary artery (LMCA) and/or multivascular CA disease (SYNTAX Score 25,8±5,0) in the long-term follow-up after CABG and PCI did not differ in MACCE, but the CABG group demonstrated a significant advantage in repeated myocardial revascularization. No significant differences were found in any study endpoint in patients after CABG on-pump versus off-pump.

Conclusions: Our study demonstrates the advantage of CABG in patients with stable CAD with stenosis of the LMCA and/or multivascular CA disease, and which CABG technique should depends on the comorbidity of the patient, the experience of the surgeon and the surgical center.


Natalia Sokolova

ГБУЗ ТО «Областная клиническая больница», Петербургское шоссе, 105, г. Тверь, Тверская область, 170036, Российская Федерация;
2 ФГБУ «НМИЦ сердечно-сосудистой хирургии им А.Н. Бакулева» МЗ РФ» Рублевское шоссе, 135, Москва, 121552, Российская Федерация;

Author for correspondence.
Email: nsokolova1711@gmail.com
ORCID iD: 0000-0002-5720-304X

Russian Federation

SPIN: 6801-7937

Elena Golukhova

Email: egolukhova@yahoo.com
ORCID iD: 0000-0002-6252-0322
SPIN-code: 9334-5672

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