PCI VERSUS CABG IN MULTIPLE VESSEL CAD


Adarsh Kumar, M.D., Govt Medical College/GND Hospital, Amritsar, India

CAD is number one killer in the world. CABG and PCI are both safe and established invasive treatment modalities for CAD. However conflicting information exists when comparing their long term efficacy in multiple vessel disease (MVD). The introduction of DES for PCI and Off Pump and MIDCAB Bypass Surgery have tremendously improved both the techniques. For Single & DVD with normal LV function and in low risk cases with EF =50% with TVD perhaps results of both modalities are similar. The recent SYNTAX trial has shown CABG to be superior to PCI in high risk patients of MVD with 5year mortality 2.3 times higher in PCI as compared to CABG especially when PVD, tobacco use, DM and heart failure are associated. For LMCA plus SVD PCI was better and for LMCA with 2VD or 3VD, CABG was better. The recent FREEDOM trial has shown that CABG for MVD with DM was associated with reduction in risk of MI and all cause mortality while PCI was associated with lower risk of stroke but more revascularisations and surgery should be preferred to PCI in such cases. To conclude, for low risk patients of MVD the PCI results were almost similar to CABG while in high risk cases and complex MVD CABG is a better option especially with SYNTAX score =22 .Refinements in PCI techniques including Fractional flow reserve guarded revascularization and improvement in stent technology are likely to strengthen the role of PCI in complex MVD.