A paper from Washington State examines the treatment of patients with multi-vessel coronary artery disease. A second paper, like the BARI-2D study and a much earlier published paper, focuses on patients with diabetes and 3VD. The short as well as long term benefits of CABG for these type of patients have been described in the SYNTAX trial as well as other publications but have rejected in daily clinical practice with a call for new studies as the most positive answer.
A dramatic increase in PCI, coupled with a similar decrease in CABG characterizes these two reviews. Undoubtedly this practice is emblamatic for similar trends worldwide.
More surprising is a continuing trend towards better outcomes in CABG, despite shrinking volumes and facing ever sicker patients.
The increase in PCI in this high risk sub group suggests a specific practice of “target lesion” revascularization rather than an emphasis on complete revascularization, not influenced by across the board recommendations from the various medical associations.
It also suggests long term considerations play little or no role in this process and that device manufacturars and economic benefit may have a much larger influence on this process than simply doing what is best for the patient.
What effect this will have on an aging and increasingly diabetic population, as well as on Health Care costs in this shrinking economy, is a growing concern.
The one notable exception is the treatment for STEMI that has greatly benefits from speedy intervention, better suited to PCI than CABG.