Revascularization Guidelines Series-The Issue of Survival and Revascularization in SIHD

Video Transcription

Video Summary

In this video, the speaker discusses the issue of survival and revascularization in stable coronary artery disease (CAD). They begin by acknowledging their grant support from NHLBI for the ischemia and ischemia CKD trial. The speaker reviews previous trials from the 70s and 80s that suggest a survival benefit of revascularization. However, more contemporary trials, such as the COURAGE trial, the BADDI 2D trial, FAME 2 trial, ISCHEMIA trial, and ISCHEMIA CKD trial, show no significant difference in mortality between revascularization and medical therapy. Various meta-analyses are also discussed, some showing a reduction in cardiac mortality with revascularization, but with small absolute risk reductions. The speaker also highlights specific subgroups where revascularization may improve survival, such as patients with left main disease, LV systolic dysfunction, triple vessel disease, proximal LAD disease, and extensive ischemia. However, it is noted that the data for these subgroups is not entirely robust. Finally, the speaker references the 2021 ACC/AHA guidelines which recommend considering CABG for left main disease and LV systolic dysfunction to improve survival, while the evidence for PCI to improve survival in triple vessel disease is uncertain. Revascularization may be considered for proximal LAD disease, but not for less severe disease. The video provides a comprehensive overview of the topic and offers insights into the current understanding of survival and revascularization in stable CAD.<br /><br />Note: No credits were given in the video transcript.

Asset Subtitle

Sripal Bangalore, MD, MHA, FSCAI

Keywords

survival

revascularization

coronary artery disease

medical therapy

mortality