Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Chronic Total Occlusion of Coronary Arteries

Abstract

Background: Chronic Total Occlusion (CTO) of coronary arteries presents a significant challenge in the management of coronary artery disease (CAD), influencing treatment outcomes and patient prognosis. Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) are two predominant revascularization strategies employed, each offering distinct benefits and limitations. Objective: This study aims to compare the efficacy and safety of PCI and CABG in managing patients with CTO, to inform clinical decision-making and optimize treatment approaches. Methods: A retrospective analysis was conducted at Lady Reading Hospital, Peshawar, from January 1, 2021, to December 31, 2023. We included 145 patients diagnosed with CTO who underwent PCI (n=65) or CABG (n=80). Data were collected on patient demographics, clinical features, lesion characteristics, procedural details, and follow-up outcomes. Major Adverse Cardiac Events (MACE) and quality of life measures were the primary endpoints. Statistical analysis was performed using SPSS version 25, employing Mann-Whitney U and Chi-square tests for continuous and categorical variables, respectively. Results: The procedural success rate was 84.6% for PCI and 90% for CABG. MACE occurred in 23.1% of the PCI group and 15% of the CABG group. The average hospitalization duration was 5.8 days for PCI and 8.5 days for CABG. Quality of life assessments showed comparable scores between groups, with PCI scoring 80.6 on the Seattle Angina Questionnaire and CABG scoring 79.8. Conclusion: PCI and CABG demonstrated similar efficacy and safety profiles in the management of CTO, underscoring the need for individualized treatment strategies based on patient-specific factors. Both methods proved viable, with slightly higher procedural success in CABG and comparable quality of life outcomes.