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Optimal revascularisation for patients with complex lesions or multivessel coronary artery disease

Cardiovascular Surgery

Dr. Weintraub presented the potential value of registries, describing the ASCERT study of almost 190,000 patients undergoing PCI (almost 80% with DES) or CABG in patients aged over 65 years.  The study (published in the NEJM 2012) reported 4.4% superior survival with CABG at 4 years.  Findings persisted across 10 subsets of patients. 

Dr. Farooq presented the importance of scoring systems to allow improved prediction of likely outcome in patients undergoing PCI or CABG.  He described the SYNTAX II Study (Lancet 2013) in identifying 8 variables which enabled prediction of survival in patients undergoing PCI or CABG. 

Dr. Girerd described the adverse impact of incomplete revascularisation on long term survival and especially in younger patients. Dr Kappetein presented the Freedom Trial in patients with diabetes where CABG had a 5.4% survival advantage at 5 years over PCI.  Similar findings were observed in the subset of patients with diabetes in the SYNTAX Trial. 

Dr. Taggart summarised the session emphasising (i) that previous RCTs of PCI versus CABG (with the exception of the SYNTAX Trial) had enrolled highly selected patients who were quite different from most CABG patients; (ii) that the survival advantage of CABG over PCI did not usually emerge until 3-5 years; (iii) the difference between appropriate and inappropriate complete revascularisation (during PCI and CABG). Finally, he emphasised the importance of interventions in individual patients being overseen by the heart team rather than by individual practitioners to ensure that patients were likely to receive the optimal intervention, whether by PCI or CABG.




Optimal revascularisation for patients with complex lesions or multivessel coronary artery disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.