FREEDOM Trial (NEJM 2012)
- Diabetic patients with multivessel CAD (N=1900)
- Revascularization with CABG reduced mortality (16.3% vs. 10.9%, P=0.049)and MI (13.9% vs. 6.0%, P<0.001) compared to PCI
- CABG associated w/ modest increase in the rate of stroke (2.4% vs. 5.2%, P=0.03).
Posted 03/21/17 09:21:03 AM by Matthew Cummings
BEST Trial (NEJM 2015)
- Non-inferiority trial examining PCI w/ 2nd generation DES vs. CABg for multivessel CAD
- 880 patients (438-PCI group and 442-CABG group) w/ multivessel CAD
- Rate of major adverse CV events higher among those s/p PCI (11%) with the use of everolimus-eluting stents than among those s/p CABG (7.9%).
- Why is CABG typically preferred for multivessel/LM disease? Bypass longer segments of atherosclerosis, pre-emptively exclude vulnerable plaques, avoid future clinical events.
Posted 03/21/17 09:25:27 AM by Matthew Cummings
SYNTAX score -- tool to score complexity of CAD
- Angiographic grading tool to determine the complexity of CAD
- Useful differentiator for the outcome of patients undergoing triple vessel PCI --> highest scores have highest risk
- Sum of the points assigned to each individual coronary lesion with >50% diameter narrowing in vessels >1.5mm diameter
- Coronary arteries divided into 16 segments
- Each segment given a score of 1 or 2 based on the presence of disease and this score is then weighted (e.g. 3.5 for the prox LAD, 5.0 for LM, and 0.5 for smaller branches).
Posted 03/21/17 09:35:27 AM by Matthew Cummings
Posted 03/21/17 09:40:14 AM by Matthew Cummings
Created by Christopher Kelly
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