Presentatie - vzw farmaka asbl

CABG vs enkel medicatie
Gami P. Secondary prevention of ischaemic cardiac events. Clinical Evidence 2007.
Design N/n Population Interventions Outcomes Results
SR N=7, -Coronary artery disease
-CABG Death -RR=0.61 in favour of CABG
n=2649 -Mostly male
-Medication at 5 years (95%CI 0.48 to 0.77)
-41-60 y
only Death -RR= 0.83 in favour of CABG
-80% ventricular ejection fraction > 50%
at 10 years (95%CI 0.70 to 0.98)
-60% prior MI
-83% with 2 or 3 vessel disease
Death or MI -11.6% (CABG) vs 8%
at 1 year -RR=1.45 (95%CI 1.18 to 2.03)
The results of the systematic review may not be easily generalised to current practice. People were aged 65 years or younger,
but more than 50% of CABG procedures are now performed on people over 65 years of age. In addition, almost all were male
and high risk people, such as those with severe angina and left main coronary artery stenosis, were under-represented.
Internal thoracic artery grafts were used in fewer than 5% of people. Lipid lowering agents (particularly statins) and aspirin
were used infrequently (aspirin used in 3% of people at enrolment). Only about 50% of people were taking beta-blockers. The
systematic review may underestimate the real benefits of CABG in comparison with medical treatment alone because medical
and surgical treatment for coronary artery disease were not mutually exclusive; by 5 years, 25% of people receiving medical
treatment had undergone CABG surgery and by 10 years, 41% had undergone CABG surgery. The underestimate of effect
would be greatest among people at high risk. People with previous CABG have not been studied in RCTs, although they now
represent a growing proportion of those undergoing CABG.
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