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.