Getting to Know Coronary Artery Disease Treatment: PCI vs CABG

Obstructive coronary artery disease (CHD) is a heart disease that occurs when the coronary arteries become narrowed or even closed due to plaque buildup. Patients and physicians typically have two treatment choices for obstructive coronary artery disease: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Both treatments have demonstrated efficacy in treating the condition, but there are significant distinctions between them.

In comparison to PCI, CABG offers substantial survival benefits and significant reductions in myocardial infarction and need for repeat revascularization in multivessel disease in patients with intermediate and high severity disease, whereas for left main disease these benefits are largely observed in patients with the highest-severity disease. In general, the benefits of CABG are further enhanced in patients with diabetes and/or impaired ventricular function. In stable or urgent clinical situations most decisions for intervention should be agreed by a multidisciplinary group (‘Heart Team’), incorporating the severity of coronary artery disease (CAD) and the patient's overall clinical suitability and personal wishes for any proposed procedure.

either multi-vessel disease (MVD) or minimally invasive neurosurgical surgery or left main disease (LMD) or coronary artery disease with angiographic features or considered as spectrum of coronary artery disease (CAD) in terms of intervention and outcomes. However, more recently, several randomized trials and large registries have now clearly documented different clinical outcomes following intervention with coronary bypass graft surgery (CABG) or percutaneous coronary interventions (PCI) in patients with MVD (particularly those with diabetes) and LMD.

Crucial to any interpretation and understanding of clinical outcomes are three basic and fundamental concepts: assessing the baseline characteristic of the study patient populations (often in studies not typical of routine clinical practice); the duration of follow-up (which should be over an absolute minimum of 5 years and ideally 10 years to ensure clinical relevance); and quantifying the use of optimal therapy (usually significantly inferior for CABG vs PCI patients).

The suitability of CABG compared to PCI for patients with coronary artery disease (CAD) remains a controversial issue. Despite growing evidence supporting the clinical efficacy of these revascularization strategies, there is little evidence regarding their long-term cost-effectiveness. The aim of this study was to critically evaluate the literature regarding the cost-effectiveness of CABG compared to PCI and assess the quality of the available economic evidence.The methods is a systematic review was conducted using three databases: PubMed, Scopus and Google Scholar. Three studies were retrieved then compared the economic evaluation of CABG vs PCI measures The result is the improvement (ICER) reported across studies varied widely by perspective and timeframe. ICER calculation was reported to be favorable and cost effective for CABG. The conclusions is CABG is more cost-effective than PCI in cases of coronary artery disease. The evidence supporting this cost-effectiveness will continue to evolve and further evaluation over a period of 10 years or more is needed considering societal perspectives.

Minimally invasive coronary artery bypass grafting (CABG) is a surgical procedure for treating blocked or narrowed arteries in the heart. It involves taking a healthy blood vessel from elsewhere in the body and attaching it to the artery beyond the blockage to create a detour for blood flow. During minimally invasive CABG, the surgeon accesses the heart through a small incision between the ribs without having to cut bones. There's no need to stop the patient's heart, and most patients don't have to be on a heart-lung bypass machine.

There's a much faster recovery time, a lower risk of complications, and less pain and scarring. This makes it a good option for the many heart disease patients who are elderly, frail or have additional health problems, and cannot safely undergo open-heart surgery.

Awareness of potential concerns, as well as thorough attention to equipment positioning and patient monitoring, can help to reduce the likelihood of difficulties and allow for rapid treatment if dangers arise. Today, there are devices that can be used in conjunction with artificial intelligence techniques as an effective form of monitoring patients with heart diseases.

Implementing technology could help reduce the number of visits to hospitals and improve patients’ quality of life. There are often no symptoms until a heart attack occurs in patients with heart disease, therefore emphasis on the increased use of remote health diagnosis and monitoring systems to predict, prevent, and monitor heart emergencies is needed.

The following are services for the treatment of heart disease at RSU Hermina Kemayoran:

- Angiography: Cardiac catheterization, heart ring insertion.

- CABG, heart surgery.

- Minimally invasive CABG

- CT scan 128 slices.

- Electrocardiogram (ECG).

- Consultation with a heart specialist.

- Medical Check Up.

- MRI 1.5 Tesla.

- Radiotherapy.

- Treadmill test, physical examination of the heart.

 

Reference

1. Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016;388:2743-52. 10.1016/S0140-6736(16)32052-9]
2. Stone GW, Sabik JF, Serruys PW, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med 2016;375:2223-35. 10.1056/NEJMoa1610227]
3. Buszman PE, Buszman PP, Banasiewicz-Szkrobka I, et al. Left Main Stenting in Comparison with Surgical Revascularization: 10-Year Outcomes of the (Left Main Coronary Artery Stenting) LE MANS Trial. JACC Cardiovasc Interv 2016;9:318-27. 10.1016/j.jcin.2015.10.044
4. Ahn JM, Roh JH, Kim YH, et al. Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study. J Am Coll Cardiol. 2015;65:2198-206. 10.1016/j.jacc.2015.03.033
5. Morice MC, Serruys PW, Kappetein AP, et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 2014;129:2388-94. 10.1161/CIRCULATIONAHA.113.006689