7%, P = 0.03). Substantial regional differences in the Poziotinib
PCI to CABG ratio of cardiac hospitals analysed in the New York Registry suggest that patient characteristics, physician biases and hospital culture significantly influence the modality of revascularization. The American College of Cardiology Foundation and the Society of Thoracic Surgeons Registries combined 86?244 patients undergoing CABG and 103?549 undergoing PCI between 2004 and 2007 for two- or three-vessel disease. Patients were 65 years or older, excluded if they were revascularized emergently or had MI within 7 days and followed-up for a median of 2.7 years. There was no difference in mortality at 1 year (CABG 6.2%, PCI 6.6%). At 4 years, mortality was lower in the CABG group (CABG 16.4% versus PCI 20.8%; relative risk (RR): 0.79, 95% CI: 0.76�C0.82). Our group has recently published a meta-analysis of trials comparing CABG with DES in patients with multi-vessel disease. MACCE at 1 year was significantly higher after PCI than CABG (RR: 1.74, 95% CI: 1.24�C2.44, P = 0.001). Repeat revascularization was more frequent after DES (RR: 4.03, 95% CI: 2.7�C6.01, P < 0.0001). CABG remains the treatment of choice for multi-vessel coronary artery disease, with a survival benefit and lower rate of MI evident at approximately 3 years and lower rate of repeat revascularization evident as early as 1 year. The results suggesting superiority of CABG in the large registry trials have been confirmed by the randomized SYNTAX trial, the strength of which lay in the ��real-world�� population of patients with three-vessel disease it recruited in Cobimetinib
contrast to the low-risk populations of previous trials. A sub-population of patients with three-vessel disease of low complexity (<22) is treated by PCI with equivalent results. The elevated rate of stroke in the surgical arm of SYNTAX at 12 months is a concern, even though there was no difference evident at 3 years �C surgeons need to focus on techniques to reduce neurological injury. CABG is recommended as a class I indication for left main coronary artery disease and has been the gold standard treatment for 3 decades.[6, 18] The left main coronary artery is an attractive target for interventional <a href="http://www.selleckchem.com/products/ganetespib-sta-9090.html
">Ganetespib cardiologists because of its large diameter and proximal position in the coronary circulation and is now a class IIa alternative to CABG for low complexity disease (SYNTAX < 22). Four randomized trials are included in a meta-analysis comparing PCI versus CABG for unprotected left main disease. The range of mean SYNTAX scores in the included trials was 24�C30 and proportion with three-vessel disease was 14�C68%. At 1 year, there was a difference in MACCE between groups (CABG 11.8% versus PCI 14.5%, P = 0.11). In patients with left main and three-vessel disease, PCI had a significantly higher rate of MACCE than CABG (CABG 10.4% versus PCI 17.9%, P = 0.03). The rate of stroke was lower in PCI (CABG 1.7% versus PCI 0.1%, P = 0.