PUBLICATIONS WHICH MAY AFFECT OUR PRACTICE

On-pump versus off-pump coronary-artery bypass surgery. Veterans Affairs Randomized On/Off Bypass. (ROOBY) Study Group. Shroyer AL. N Engl J Med. 2009 Nov 5;361(19):1827-37.The study included 2203 patients scheduled for urgent or elective CABG, randomly assigned to either on-pump or off-pump procedures. At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources.

Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. Stassano P. J Am Coll Cardiol. 2009 Nov 10;54(20):1862-8. Three-hundred and ten patients aged 55 to 70 years were randomized to recieve a bioprosthetic or a mechanical aortic valve. At 13 years, patients undergoing aortic valve replacement either with mechanical or bioprosthetic valves had a similar survival rate as well the same rate of occurrence of thromboembolism, bleeding, endocarditis, and MAPE, but patients who had undergone aortic valve replacement with bioprosthetic valves faced a significantly higher risk of valve failure and reoperation

A randomized trial of therapies for type 2 diabetes and coronary artery disease. BARI 2D Study Group. Frye RL. N Engl J Med. 2009 Jun 11;360(24):2503-15. The study included 2368 patients with both type 2 diabetes and heart disease randomly assigned to undergo either prompt revascularization with intensive medical therapy or intensive medical therapy alone. In the PCI group there was no significant difference in primary end points between the revascularization sub-group and the medical-therapy sub-group. In the CABG group the rate of major cardiovascular events was significantly lower in the revascularization sub-group (22.4%) than in the medical-therapy sub-group (30.5%, P=0.01).

Coronary bypass surgery with or without surgical ventricular reconstruction.  STICH Hypothesis 2 Investigators. Jones RH. N Engl J Med. 2009 Apr 23;360(17):1705-17. Adding surgical ventricular reconstruction to CABG was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes.

Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Hlatky MA. Lancet. 2009 Apr 4;373(9670):1190-7. Long-term mortality is similar after CABG and PCI in most patient subgroups with multivessel coronary artery disease, so choice of treatment should depend on patient preferences for other outcomes. CABG might be a better option for patients with diabetes and patients aged 65 years or older because we found mortality to be lower in these subgroups.

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.SYNTAX Investigators. Serruys PW. N Engl J Med. 2009 Mar 5;360(10):961-72. CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. FAME Study Investigators.Tonino PA. N Engl J Med. 2009 Jan 15;360(3):213-24. Routine measurement of FFR (the ratio of maximal blood flow in a stenotic artery to normal maximal flow) in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.