Нда, зато при двух- и трехсосудистом КШ пока еще лучше покрытых стентов:Абугов писал(а):Ой, ну и нифига себе...
PCI better than CABG for unprotected left main coronary artery stenosis
А почечные дозы дофамина все-таки существуют:Revascularization for Multivessel Disease: CABG or PCI?
For most patient groups, 18-month outcomes were better with CABG.
Patients with multivessel coronary artery disease are treated with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, limited data are available on outcomes with traditional CABG versus PCI with newer drug-eluting stents (DES). In this observational comparison from New York State, 9963 patients underwent PCI-DES and 7437 underwent CABG for multivessel disease in 2003 and 2004.
Statistical analyses were adjusted for substantial baseline demographic and clinical differences between the two groups. Mean follow-up was 19 months. Among patients with 3-vessel disease, rates of death (hazard ratio, 0.80) and myocardial infarction or death (HR, 0.75) were significantly lower for CABG than for PCI-DES. Among patients with 2-vessel disease, HRs for death (0.71) and for MI or death (0.71) also significantly favored CABG over PCI-DES. Overall, CABG patients had lower rates of repeat revascularization than did PCI-DES patients. In the diabetes subgroup, no significant difference in mortality was noted between treatment groups, but CABG patients had substantially lower rates of MI or death than did PCI-DES patients (P=0.07).
Comment: Like an earlier analysis of CABG versus PCI with bare-metal stents (Journal Watch Nov 29 2002), these results with drug-eluting stents suggest that CABG results in lower 18-month mortality for patients with multivessel disease. This conclusion is limited by the observational study design and possible unmeasured differences between groups. Nonetheless, given the
large number of patients studied and the careful analysis, these findings warrant serious consideration when treatment options are considered for patients with multivessel CAD.
Kirsten E. Fleischmann, MD, MPH
Published in Journal Watch General Medicine February 5, 2008 Citation(s):
Hannan EL et al. Drug-eluting stents vs. coronary artery bypass grafting in multivessel coronary disease. N Engl J Med 2008 Jan 24; 358:331.
http://circ.ahajournals.org/cgi/content ... 2/200?etoc
