Professor Abdus Samad MD FACC Karachi Institute of Heart Diseases Karachi, Pakistan May 1, 2010

Professor Abdus Samad MD FACCKarachi Institute of Heart Diseases

Karachi, PakistanMay 1, 2010

Best is the enemy of Better !

Mauluna Abdul Haque – Baba -ye- Urdu dictionary

Patient no – 1800 PCI group – 17.8% CABG group – 12.4 % P value – 0.02 All Comers

Death, Stroke or MI - CABG – 7.7 % - PCI – 7.6 % (1000 = 1)

Stroke - PCI – 0.6 % - CABG – 2.2 % (1000=16)

no of patients – 510 Primary outcome 1. All cause mortality 2. MI 3. Stroke Result : - CABG – 10.5% - PCI – 13% (1000=25)

All cause mortality at 1 year - CABG – 3.2 % - PCI - 3.2 %

Primary Outcome - DES (69%) vs CABG - CABG (12.4%) - DES (11.6%) (1000=8)

No of patients – 607 Diabetic Patients - SES - 15.0 % - CABG - 16.7% (1000=17) Non- Diabetics - SES - 11.8 % - CABG - 13.3 % (1000=15)

No of Patients – 7818 Odds ratio – 1.69 CI – 95% ( 1.27 – 2.1 )

23 RCTs in which 5019 patients were randomly assigned to PCI and 4944 patients were randomly assigned to CABG.

Pooled analysis of 3051 patients in 4 randomized trials evaluating the relative safety and efficacy of PCI with stenting and CABG at 5 years for the treatment of multivessel coronary artery disease.

The primary end point was the composite end point of death, stroke, or myocardial infarction.

Death/MI/CVA=stenting versus CABG (16.7% versus 16.9%, HR 1.04, 95% CI, 0.86 to 1.27; P=0.69).

Repeat revascularization (29.0% versus 7.9%, HR 0.23; 95% CI, 0.18 to 0.29; P<0.001).

In the era of DES, there is no difference between PCI and CABG in terms of survival or future risk of MI.

CABG is associated with higher risk of stroke.