Coronary Artery Bypass Graph Case Study
Rationale for selecting article:
As a nurse, I have interacted with patients who have required coronary artery bypass graphs, although this is a recent experience; before this I had not been involved in these procedures. It is a serious medical procedure, as most procedures involving the internal organs are, particularly with regard to the human heart. CABG are used by surgeons to treat people with coronary heart disease (CHD). Plague within the heart hardens and then narrows the coronary arteries, reducing flow of blood to the heart which can result in a blood clot. CABG allow for the needed blood to get through the heart by bypassing the blocked artery. During the procedures, patients are anesthetized and then a healthy artery or vein is taken from another part of the body and connected to the blocked coronary artery. The article chosen is entitled “Percutaneous Coronary Intervention vs. Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease” and examines the treatments available for patients with CAD and CHD and whether or not CABG is still a viable solution.
2. Problem Statement:
Researchers looked at both percutaneous coronary intervention and CABG to determine which of the two methods would best treat patients with CHD in modern hospital settings (Serruys et. Al. 2009,-page 961). There is as yet no one treatment which has gained universal acceptance as a means of treating or curing patients dealing with heart disease. CABG is a method which has been around longer and most medical technicians believe that it is the best treatment of all the ones available for treating coronary heart disease, but percutaneous coronary intervention also has its supporters. The two methods have never been directly compared in scientific research, which is the reason this survey was conducted.
A SYNTAX trial was conducted which looked at the consecutive enrollment of all eligible patients who had been diagnosed with three-vessel or left main coronary artery disease.
4. Research Design:
85 different medical sites were chosen to participate in the experiment to get a wider range of results and thereby increase the validity and universality of the findings. These testing sites were in 17 different countries throughout both Europe and the United States (Surruys et. Al 2009,-page 963). The intention was to get as wide an array of subjects as possible in order to eliminate biases in the test.
b. Subjects included in the research:
A panel of medical professionals determined which patients of those who were diagnosed with the heart condition but who had not yet been treated should be included in the experiment. Criterion included whether they had had previous treatment and this was a recurrence which would have eliminated them from the study. Patients involved were chosen at random to have either CABG or PCI treatment. Those patients who could not safely be involved in the randomization where placed in a second registry: either the PCI registry for CABG-ineligible patients or the CABG registry for PCI-ineligible patients (Surruys et. Al 2009,-page 965).
c. Sample size / number of subjects in the study:
Of 4,337 patients who were examined as potential subjects for the tests, only about 3,000 were included in the study. Of that number, some 1,800 patients were randomly assigned to have CABG treatment (Surruys et. Al 2009,-page 967). The other 1200 patients were randomly assigned to have the PCI treatment for their condition.
d. Conditions under which data was collected:
Angiograms and electrocardiograms were reviewed by staff members; members were not aware which of the two designated treatments the patient had been assigned to. This insured that the results of treatment were not biased based upon personal opinion of the person reviewing the data. The numbers were then compared to the patient’s pre-surgical statistics. In this way, researchers were able to find which was statistically more successful in treating patients, CABG or PCI.
e. Researcher’s plan to analyze findings:
After the researchers received the data, they were to look at it and try to assess just the numbers, which patients had a better recovery and which ones had less successful recoveries. Being blinded as to the results of which treatment provided what sample, the researchers hoped to eliminate personal bias and to find unbiased data.
5. Application of evidence-based nursing:
The application of the results of this study to the nursing profession is to show which treatment, CABG or PCI will best help patients with Coronary Heart Disease. As a nurse, it is part of the job to suggest treatments which are effective and will help the patient recover from illness and injury. Understanding the best likelihood for a successful surgery will assist the patient and hopefully increase the probability of the patient’s successful recovery.
6. Results / Findings of the study:
Following the study, researchers found that the level of success between patients who had CAPG treatment and those who had PCI treatment were relatively balanced. There were certain indications revealed with regard to other symptoms. For example, blood pressure percentages were significantly higher in patients who had PCI treatment than those who had CAPG. There was a larger number of patients who had blood pressure readings higher than 130/80. The patients treated were all high-risk and therefore had little to lose by participating in the treatment. Of this number, about 20% were left permanently weakened by either surgery, indicating no difference on this front. On average, more than four “clinically significant coronary lesions were treated per patient” (Serruys et. Al 2009,-page 970). Of that number, the patients who underwent CABG were approximately 1% more successful than the patients who underwent PCI. Other indications of the test comparison similarly showed CABG to be the superior procedures. Overall, the researchers determined that CABG was a more successful treatment method, with a better likely outcome and far less complications for patients following the surgery and suggest that this method be used rather than PCI.
Serruys, P., Morice, M., Kappetein, P., Colombo, A., Holmes, D., Mack, M., Stahle, E.,
Feldman, T., van den Brand, M., Bass, E., Van Dyck, N., Leadley, K., Dawkins, K., and Mohr, F. (2009). Percutaneous coronary intervention vs. coronary-artery bypass grafting for severe coronary artery disease. The New England Journal of Medicine. 360. 961-72.
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