CABG LAST LONGER THAN DES - ANTAGONIST

I spend Sunday morning at the Gurney Hotel, Penang, to speak at the Penang GP Cardiology Seminar. They had me take part in a debate with Dr Hafiz Law ( cardiac Surgeon ) on the topic " CABG last longer than DES ". He was the protagonist and I was the antagonist. Again, I am unable to download the slides. It does contain much laymen information.
Of course, interventionist are more matured now, and more realistic. I do agree that CABG is a more matured procedure and definitely have a longer history. However DES continues to evolve with newer and better DES, from 1st generation to 2nd, 3rd generation DES and in the near future, the disappearing stent ( bioabsorbable DES ). Of course SYNTAX trial has taught us that in CAD with low Syntax score ( 22 and below ) and high Euroscore, PCI is advantageous. In patients with medium or high scores and also high Euroscores, CABG is better, and when in doubt, a heart team consult is good for the patient, especially with severe 3 vessel CAD or left main stem CAD.
It is important to note that DES / PCI is a much lesser procedure when it is technically possible. The trade off is a high rate of re-intervention for restenosis. CABG does have graft attrition, which may come on in 5-10 years. So Trials like Syntax, at 4 years, does not do justice to PCI / DES as there is enough time for DES restenosis, but not enough time for graft failure. Also, Taxus is not the best competitor to CABG. Xience V would have been a m ore appropriate competitor with CABG. In fact, if you take Spirit 4 three years MACCE curve and superimpose on Syntax 4 years, Xience V came out just as good.
The heart-lung machine is a great stress for CAD patients and the "pump head" syndrome is a real problem.

This is my concluding slide :

CABG AND PCI, WHEN DONE BY EXPERTS, ARE BOTH GOOD MEANS OF MYOCARDIAL REVASCULARISATION. WHICH IS BETTER? IT DEPENDS ON THE PATIENT'S SYNTAX SCORE AND EUROSCORE. DECISION SHOULD BE ON A PATIENT TO PATIENT BASIS, AND NOT ON p- values AND HAZARD RATIOS.

That is how I spend 27th Nov 2011.