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Study Reinforces the Value of Open Heart Surgery in Multivessel Disease

Thomas Togioka';

By Thomas Togioka

Posted on October 23rd, 2019 in Thoracic & Vascular Surgery

Open Heart Surgery in Multivessel DiseaseAccording to the study published in the journal, The Annals of Thoracic Surgery, coronary artery bypass grafting (CABG) is the best treatment option for patients with multiple blocked heart arteries. CABG is the most commonly performed cardiac surgery in the US and is done to create a new course for the blood to reach the heart by bypassing the blocks in the heart arteries. During this operation, the surgeon takes a healthy blood vessel, either from the leg, arm, chest or abdomen and attaches it to the heart arteries in order to enable blood circulation to bypass the blocked portion of the coronary artery.

Data from the Study Demonstrated Significant Mortality Benefit with CABG as Compared to Percutaneous Coronary Intervention (PCI)

The benefit remained the same in all the patients, which suggests that CABG can be considered in the treatment plan of a broader group of patients, not only in patients with diabetes and left ventricular dysfunction.

PCI or angioplasty is a nonsurgical technique that makes use of a thin, flexible catheter that is passed into an artery in the arm or groin region. Once it reaches the narrowed coronary artery, the balloon at the end of the catheter will be inflated to open the blockage. Sometimes, a metal mesh or stent may be left behind to avoid the narrowing of the artery again.

The researchers of the study examined the data derived from the two major clinical outcomes registries namely the American College of Cardiology Foundation National Cardiovascular Data Registry (NCDR) and the Society of Thoracic Surgeons (STS). In these registries, they identified the patients with multivessel coronary artery disease who had undergone either CABG or PCI between 2010 and 2018 at the University of Pittsburgh Medical Center (UPMC). The patients who met the eligibility criteria were divided into two different groups called CABG and PCI with 844 patients included in each group. The analysis was made on outcomes for factors such as mortality, revascularization, and readmission. It was found that the estimated 1-year mortality in patients included in the CABG group was 7.2% whereas it was 11.5% in patients of the PCI group. Also, the CABG group experienced a lower risk of revascularization (1% versus 6.7%) and hospital readmission (28.1% versus 38.4%) compared to the PCI group. Thus, the study based on real-world analyses provides better insights about making clinical decisions.

The Decision between PCI and CABG for Treatment in Patients with Multiple Blocked Arteries Is Not Always Straightforward

Though the study reveals that CABG outperforms PCI in all groups of patients, it is important to make complex treatment decisions along with guidance from a heart care team that generally includes cardiothoracic surgeons, cardiologists, and other health care providers. Overall, a multidisciplinary team approach can ensure informed decisions, improved efficiency and advanced care for patients.