percutaneous coronary intervention versus coronary artery bypass grafting

Last reviewed 01/2018

Percutaneous coronary intervention versus coronary artery bypass grafting

• when advising patients about the choice of revascularisation strategy (PCI or CABG), the clinician should take account of coronary angiographic findings, comorbidities, and the benefits and risks of each intervention
• when the role of revascularisation or the revascularisation strategy is unclear, resolve this by discussion involving an interventional cardiologist, cardiac surgeon and other healthcare professionals relevant to the needs of the patient. Discuss the choice of revascularisation strategy with the patient

Notes:

• as soon as the diagnosis of unstable angina or NSTEMI is made, and aspirin and antithrombin therapy have been offered, formally assess individual risk of future adverse cardiovascular events using an established risk scoring system that predicts 6-month mortality (for example, Global Registry of Acute Cardiac Events [GRACE])
  • include in the formal risk assessment:
    • a full clinical history (including age, previous myocardial infarction [MI] and previous percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG])
    • a physical examination (including measurement of blood pressure and heart rate)
    • resting 12-lead electrocardiography (ECG) (looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia)
    • blood tests (such as troponin I or T, creatinine, glucose and haemoglobin)

• Predicted 6-month mortality	Risk of future adverse cardiovascular events
  1.5% or below	lowest
  > 1.5 to 3.0%	low
  > 3.0 to 6.0%	intermediate
  > 6.0 to 9.0% over 9.0%	high
  over 9.0%	highest

Reference:

• 1) NICE (March 2010). Unstable angina and NSTEMI The early management of unstable angina and non-ST-segment-elevation myocardial infarction