CABG VS PCI

CABG VS PCI my perspective iDR.NILESH TAWADEJASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI

CABG VS PCIPCICABG

CABG VS PCI

Evidence from trials comparing CABGvs. PCI

Optimal Revascularization Strategy in Patients With Three-Vessel Disease and/or Left Main Disease

SYNTAX 5-year Outcomes ESC 2012 Mohr August 2012

The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery:The SYNTAX Study

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LeftMainTortuosity3 VesselThrombusBifurcationCTOCalcificationSYNTAXSCORENo. &Locationof lesionDominanceLOW SCORE < 22

INTERMEDIATE SCORE 23 32

HIGH SCORE >33 PATIENTS CORONARY ANATOMY WAS STRATIFIED ACCORDING TO SYNTAX SCORE

CORONARY ANATOMY WAS STRATIFIED ACCORDING TO SYNTAX SCORE 6

Summary at 5 yrs

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SUB GROUP ANALYSIS

SUB GROUP ANALYSIS8

SUB GROUP ANALYSIS

SUB GROUP ANALYSIS

CLINICAL TRIAL EVALUATES CHOICE OF TREATMENT FOR LEFT MAIN CORONARY DISEASESYNTAX trial found that PCI with the first generation of paclitaxel-eluting stents in patients with low- intermediate SYNTAX scores had similar outcomes with PCI compared to CABG.

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LEFT MAIN SUBSETPCI outcomes were "EXCELLENT" relative to CABG in those with Left Main Isolated (n=91) and Left Main Plus One-vessel Disease (n=138) and Left Main Plus Two-vessel Disease (n=218)

NO SIGNIFICANT DIFFERENCES in MACCE between CABG and PCI.

BUT FOR Left Main And Three-vessel Disease (n=258), CABG BETTER: MACCE 29.9% in CABG v/s 44.0% in PCI (p=0.04).

Revascularization with PCI has comparable safety and efficacy outcomes to CABG in left main subsets .

PCI is a Reasonable treatment Alternative when the SYNTAX score is Low (