This post was authored by William J Oetgen, MD, MBA, FACC, ACC's senior vice president of Science and Quality.
Results from the ASCERT study released today during the final Late-Breaking Clinical Trial session found that patients who underwent PCI had a higher death rate in the first four years after treatment than those who had opted for coronary artery bypass graft (CABG) surgery. The study, which used combined patient data from the ACC’s CathPCI Registry, the Society of Thoracic Surgeons CABG database and the Medicare claims database, suggests better survival in patients undergoing CABG compared to PCI.
While past studies have suggested that the two treatments have similar long-term outcomes, others have shown better outcomes with CABG. Patents and doctors tend to choose the less-invasive PCI when both treatments are an option. Recently updated ACCF/AHA Guidelines for CABG and PCI state that PCI to improve patient survival is a reasonable alternative to CABG in stable patients with left main CAD who have a low risk of PCI complications and an increased risk of adverse surgical outcomes. The guidelines also confirm the superiority of CABG compared to medical therapy and to PCI for most patients with 3-vessel disease.
Should physicians start recommending CABG over PCI as a result of this study? The answer is no. A major limitation of observational studies, such as this one, is that the groups may not have the same level of risk, and so it is possible that the worse outcomes in the PCI patients were related to these patients being sicker overall. These results do, however, underscore the importance of the Guideline-recommended “heart team” approach to determine which procedure should be used. This approach means that the interventional cardiologist and the cardiac surgeon review the patient’s condition, determine the pros and cons of each treatment option, and then present this information to the patient, allowing him or her to make a more informed decision. Results from studies like ASCERT should be shared with patients as part of the decision-making process.
Read more on the study here.