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MedicalAs an initial management strategy in patients with stable coronary arterydisease, PCI did not reduce the risk of death, myocardial infarction, or othermajor cardiovascular events when added to optimal medical therapy. COURAGE Trial N Engl J Med 2007; 356:1503-1516April 12, 2007
Interventional technique To relive the stenosis Balloon angioplasty , stenting Atherectomy Mortality <1%
Significant left main artery disease Triple vessel disease Two vessel disease involving the proximal LAD Poor left ventricular functionCABG remains the standard of care for patients with three-vessel or left maincoronary artery disease, since the use of CABG, as compared with PCI,resulted in lower rates of the combined end point of major adverse cardiac orcerebrovascular events at 1 year. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.- SYNTAX trial N Engl J Med. 2009 Mar 5;360(10):961-72. Epub 2009 Feb 18
Preoperative o MI from stress, anxiety or critical ischemia. Intraoperative o Myocardial failure and lack of adequate myocardial contraction at the end of bypass o Embolic infarction Postoperative o Myocardial failure o Infarction o Inadequate myocardial protection or excess fluid load. o Stroke o Arrhythmias o Wound o And other complications of open heart surgery.
stabilization devices hold heart in place allowing operation while positioning devices allow the surgeon to lift the beating heart to access the lateral and posterior vessels procedure is safe and well tolerated by most patients; however, OPCAB surgery remains technically more demanding
OPCAB decreases in-hospital morbidity (decreased incidence of chest infection, inotropic requirement, supraventricular arrhythmia), blood product transfusion, ICU stay, length of hospitalization, and decreased CK-MB and troponin I level no significant difference in terms of survival at 2 years, frequency of cardiac events (MI, PCI, CHF, recurrent angina, redo CABG) or medication usage compared to on-pump CABG
Repair of left ventricular aneurysm Repair of post infarction VSD Acute ischemic MR Surgery for ischemic ventricular arrhythmias Transplantation Ventricular assist devices.