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Multivessel Coronary artery disease – Best Course

Multivessel Coronary artery disease – Best Course. Professor Abdus Samad MD FACC Karachi Institute of Heart Diseases Karachi, Pakistan May 1, 2010. Best is the enemy of Better !. Intervention. Mauluna Abdul Haque – Baba -ye- Urdu dictionary. The Syntax Trial March 9, 2009.

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Multivessel Coronary artery disease – Best Course

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  1. Multivessel Coronary artery disease – Best Course Professor Abdus Samad MD FACC Karachi Institute of Heart Diseases Karachi, Pakistan May 1, 2010

  2. Best is the enemy of Better !

  3. Intervention • Mauluna Abdul Haque – Baba -ye- Urdu dictionary

  4. The Syntax Trial March 9, 2009 • Patient no – 1800 • PCI group – 17.8% • CABG group – 12.4 % • P value – 0.02 • All Comers

  5. Results • Death, Stroke or MI - CABG – 7.7 % - PCI – 7.6 % (1000 = 1) • Stroke - PCI – 0.6 % - CABG – 2.2 % (1000=16)

  6. CARDIA STUDY – JACC, Feb 2010 • no of patients – 510 • Primary outcome 1. All cause mortality 2. MI 3. Stroke • Result : - CABG – 10.5% - PCI – 13% (1000=25)

  7. CARDIA STUDY – JACC, Feb 2010 • All cause mortality at 1 year - CABG – 3.2 % - PCI - 3.2 %

  8. CARDIA STUDY – JACC, Feb 2010 • Primary Outcome - DES (69%) vs CABG - CABG (12.4%) - DES (11.6%) (1000=8)

  9. 5 year follow up of ARTS 2 • No of patients – 607 • Diabetic Patients - SES - 15.0 % - CABG - 16.7% (1000=17) • Non- Diabetics - SES - 11.8 % - CABG - 13.3 % (1000=15)

  10. ANGINA Relief with PCI – Annals of Internal medicine, March 2010 • No of Patients – 7818 • Odds ratio – 1.69 • CI – 95% ( 1.27 – 2.1 )

  11. 23 RCTs in which 5019 patients were randomly assigned to PCI and 4944 patients were randomly assigned to CABG.

  12. Survival

  13. Stroke

  14. 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).

  15. Summary Points • 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.

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