Professor Abdus Samad MD FACC Karachi Institute of Heart Diseases Karachi, Pakistan May 1, 2010

 Best is the enemy of Better !

 Mauluna Abdul Haque – Baba -ye- Urdu dictionary

 Patient no – 1800  PCI group – 17.8%  CABG group – 12.4 %  P value – 0.02  All Comers

 Death, Stroke or MI - CABG – 7.7 % - PCI – 7.6 % (1000 = 1)  Stroke - PCI – 0.6 % - CABG – 2.2 % (1000=16)

 no of patients – 510  Primary outcome 1. All cause mortality 2. MI 3. Stroke  Result : - CABG – 10.5% - PCI – 13% (1000=25)

 All cause mortality at 1 year - CABG – 3.2 % - PCI %

 Primary Outcome - DES (69%) vs CABG - CABG (12.4%) - DES (11.6%) (1000=8)

 No of patients – 607  Diabetic Patients - SES % - CABG % (1000=17)  Non- Diabetics - SES % - CABG % (1000=15)

 No of Patients – 7818  Odds ratio – 1.69  CI – 95% ( 1.27 – 2.1 )

 23 RCTs in which 5019 patients were randomly assigned to PCI and 4944 patients were randomly assigned to CABG.

 Pooled analysis of 3051 patients in 4 randomized trials evaluating the relative safety and efficacy of PCI with stenting and CABG at 5 years for the treatment of multivessel coronary artery disease.  The primary end point was the composite end point of death, stroke, or myocardial infarction.  Death/MI/CVA=stenting versus CABG (16.7% versus 16.9%, HR 1.04, 95% CI, 0.86 to 1.27; P=0.69).  Repeat revascularization (29.0% versus 7.9%, HR 0.23; 95% CI, 0.18 to 0.29; P<0.001).

 In the era of DES, there is no difference between PCI and CABG in terms of survival or future risk of MI.  CABG is associated with higher risk of stroke.