Withma Muthukumara
Lancaster Medical School, UK
Title: Case-based evaluation of the effectiveness of pci and CABG in the management of multi-vessel coronary artery disease
Biography
Biography: Withma Muthukumara
Abstract
Introduction: Multi-vessel coronary artery disease (CAD) can give rise to numerous disabling symptoms such as angina, shortness of breath (SOB) and fatigue, considerably impairing quality of life (QoL). Percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) have been developed to overcome these and increase life expectancy. The controversy over treatment preference has been a historical battle which CABG has dominated. However, the development of drug eluting stents (DES) is reducing the margin of difference in symptom improvement between the two interventions, making decisions difficult. Large randomised control trials (RCTs) such as SYNTAX, ARTSI/II and FREEDOM have set out to investigate the outcomes for each treatment and provide recommendations.
Aims: To measure QoL in terms of the symptom experience between 4 patients who had PCI/CABG and recognise the intervention providing the largest relief of symptoms. Additionally, explore the evidence behind PCI and CABG for multi-vessel CAD from RCTs and compare their outcomes with Case findings.
Method: 4 clinical cases, 2 undergoing PCI and 2 undergoing CABG, with multi-vessel CAD were selected. QoL was assessed using the Cardiovascular Limitations And Symptoms Profile (CLASP) questionnaire to explore the severity of symptoms before and after the intervention.
Results: Patients in the PCI group had an overall symptom reduction of 57.9% compared to only 38.9% in the CABG group. The greatest effect was seen in the angina category for PCI and SOB category for CABG, which resulted in a 100% relief of symptoms.
Conclusion: All patients had an improvement in symptoms to some degree, regardless of the type of intervention, but PCI patients had better outcomes across 4 more categories than CABG patients. RCTs report greater relief of symptoms following CABG, which was inconsistent with Case findings. CABG has demonstrated an increase in life expectancy and QoL in patients with SYNTAX scores ≥23 and more severe multi-vessel CAD, especially in diabetic patients, making it the treatment of choice.