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PCI better than CABG on achieving targets

Dr Rubin Minhas

CHD Clinical Lead, Medway PCT

Gillingham, Kent

Dr Millar (Letters, 12 November) has raised the comparison of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.

Recent reports including Cochrane and the ARTS study show no significant difference in either death or MI to two-three years among PCI or CABG.

Repeat revascularisation has tended to be higher with older bare-metal stents in the PCI arm of these trials, although newer drug-eluting stents (DES) showed no significant difference in overall major adverse cardiac and cerebrovascular events at a year in the ARTS and ARTS II studies.

PCI is less expensive than CABG (2004 NHS reference costs, CABG £7,066, PCI £2,609) and is cost-effective. NICE guidance recommends DES and allows multiple stenting.

PCI has made substantial contributions to NSF revascularisation targets while patients have benefited from a less invasive procedure and shorter waiting times.

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