Showing papers by "A. Pieter Kappetein published in 2011"
TL;DR: Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small.
Abstract: BACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown. METHODS: In a large, randomized trial, we assigned 1800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxeleluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status). RESULTS: The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P = 0.04 and P = 0.03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%, P = 0.05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period. CONCLUSIONS: Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.). Copyright
250 citations
TL;DR: The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score and risk factor analysis revealed left main disease and incomplete revascularization as predictive for adverse 2-year outcomes.
132 citations
TL;DR: Although PES is a potential treatment option in patients with less complex lesions, CABG should be the revascularization option of choice for patients with more complex anatomic disease, especially with concurrent diabetes.
94 citations
TL;DR: The 4th EACTS Adult Cardiac Surgery Database report w1x as mentioned in this paper contains an analysis of over 1,000,000 patients from 366 hospitals in 29 countries, most submitting countries are in Europe, but also have important contributions from China including Hong Kong.
Abstract: The EACTS annual meeting in Geneva this September saw the release of the 4th EACTS adult cardiac surgery database report w1x. It contains an analysis of over 1,000,000 patients from 366 hospitals in 29 countries. Most submitting countries are in Europe, but we also have important contributions from China including Hong Kong. It is a voluntary database and some countries submit data on all cardiac surgery operations undertaken, others only for surgery performed in a smaller numbers of hospitals. It is testament to the professional societies representing cardiac surgery in these countries, along with the hospitals and surgeons involved, that data from so many patients have been collected in registries and further tribute to the trust placed in EACTS and their partners that these data have been returned and permissions granted for analysis. The report gives many interesting findings, including variation in the proportion of cardiac surgery that is isolated coronary artery bypass surgery (CABG), with an overall proportion of 56.8% in the database, ranging from 29.7% to 79.6% across countries. Over time there are trends towards a decreasing proportion of CABG along with an increase in valve surgery for the larger contributing countries. The majority of countries have returned mortality data for analysis, and this is close to complete in 18 countries and complete in more than 95% of patients for a further three. Four countries have submitted no mortality data. Overall mortality for isolated CABG is 2.2% (ns219,053), for isolated valve surgery 3.7% (ns75,247) and for combined valve and CABG 6.2% (ns37,721). These data from so many patients should act as useful crude contemporary benchmarks.
50 citations
38 citations
2 citations
TL;DR: In a recent issue of the Journal, Park et al. presented long-term follow-up results from the Asan-Multivessel Registry in which patients are followed after percutaneous coronary intervention with drug-eluting stents or coronary artery bypass grafting for the treatment of heart attack patients.
1 citations
TL;DR: A meta-analysis of short-term and long-term survival after mitral valve repair or replacement for ischemic regurgitation was published in which several details are missing.
Abstract: Although meta-analyses are considered to be of great value to establish an overall effect on an investigated outcome, there are some basic ‘rules’ to such an analysis. Several statements have guided authors in reporting results from systematic reviews and have been increasingly cited to inform readers of the quality of the review [1]. In the March 2011 issue, however, a meta-analysis of short-term and long-term survival after mitral valve repair or replacement for ischemic regurgitation was published in which several details are missing [2].
1 citations