?? Invasive Treatment of "Stable" Chronic CAD: Insights and Evidence
?? Welcome to CardioBuzz, your go-to source for the latest in cardiology!
?? In our latest episode, we explored the conservative management of coronary artery disease. We discussed:
? The role of lifestyle interventions and medications like lipid-lowering agents, anti-inflammatory drugs, and antithrombotics in managing coronary artery disease.
? Strategies to relieve angina through non-invasive methods.
This week, we focus on the invasive management of CAD, addressing two vital questions:
? What is the benefit of revascularization on top of medical therapy?
? For those requiring revascularization, which approach is better: PCI (percutaneous coronary intervention) or CABG (coronary artery bypass graft)?
?? Watch the full episode: Link to YouTube video.
? Key Takeaways
1?? Medical Therapy vs. Revascularization
?? Revascularization provides better angina relief, reduces myocardial infarction (MI), and improves cardiac mortality compared to medical therapy alone.
?? A comprehensive meta-analysis of 25 randomized trials (20,000+ patients) showed revascularization reduced:
? Cardiac death by 21% ??????
? Spontaneous MI by 26% ??
?? The benefits are more pronounced over time, making revascularization a game-changer for eligible patients.
2?? PCI vs. CABG
?? PCI: Minimally invasive ??, faster recovery ??♂?, but less durable with higher rates of repeat procedures.
?? CABG: More durable ???, especially in high-complexity cases, but involves a longer recovery and higher initial risk ??.
?? Decision-making depends on:
? Anatomical complexity (evaluated using tools like the SYNTAX score ??).
领英推荐
? Patient complexity (surgical risk assessed through tools like the STS score ????).
3?? Guideline Recommendations
?? In low-complexity coronary disease, PCI is preferred.
?? In high-complexity coronary disease, CABG is superior unless the patient is at high surgical risk.
?? In left main disease, CABG is generally recommended for its durability, but PCI remains an option in low-complexity cases.
?? The Role of Evidence, Resources, and Patient Preferences
Medical decision-making relies on three pillars:
1?? Evidence: Randomized trials and meta-analyses guide decisions. ??
2?? Resources: Availability of devices or expertise may influence the feasibility of PCI or CABG. ??
3?? Patient Preferences: Individual needs, cultural factors, and values are central to crafting the best treatment plan. ??♂???
?? Looking Ahead
In our next episode, we’ll dive into angina or ischemia with non-obstructive coronary arteries (INOCA). ?? Stay tuned as we explore the types, diagnostic tools ??, and treatment strategies for this often-overlooked condition.
?? Let’s Discuss:
What are your thoughts on the balance between PCI and CABG? How do you approach revascularization decisions in your practice?
?? #Cardiology #CoronaryDisease #Revascularization #PCI #CABG #HeartHealth ??
General Manager at Medical
2 个月???? ??????
Professor ot Cardiology & Interventional Cardiologist
2 个月https://pubmed.ncbi.nlm.nih.gov/34002203/ Mohamed Salah Noshi
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32714-9/abstract
https://www.nejm.org/doi/full/10.1056/NEJMoa070829
Consultant Interventional Cardiologist at Mediclinic Middle East Dubai
2 个月The SYNTAX score has been central to assessing anatomical complexity in coronary artery disease; however, advancements such as physiology-guided PCI, newer stents, drug-coated balloons, intravascular imaging, and innovative tools for calcified lesions may challenge its current role. Newer scoring systems that incorporates these innovations could redefine how we assess and address complexity, making the SYNTAX approach re-evaluated and paving the way for more precise and individualized treatment strategies.