DES ‘comparable to CABG’ in left main disease
MedWire News: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is comparable to coronary artery bypass grafting (CABG) surgery for the treatment of unprotected left main coronary artery (LMCA) disease in terms of death, myocardial infarction, and stroke at 3 years’ follow-up, research shows.
However, the markedly higher rate of repeat revascularizations with DES remains the “Achilles heel” of the procedure, say the researchers, which they warn leads to a higher incidence of major adverse cardiac and cerebrovascular events.
For several decades CABG has been the treatment of choice for patients with significant unprotected LMCA stenosis.
“Recent improvements in PCI techniques and the introduction of DES have indicated the need for a paradigm shift in the treatment of LMCA lesions,” say Dong-Ju Choi (Seoul National University Bundang Hospital, Republic of Korea) and colleagues.
Noting a paucity of data comparing strategies in this setting, the researchers identified 462 patients who were treated from January 2003 to December 2006 for unprotected LMCA or LMCA-equivalent disease.
Of these, 257 had undergone CABG and 205 had undergone PCI with DES. Choi et al compared clinical outcomes using propensity scores to minimize the selection bias.
After a median follow-up of 33.5 months, no significant difference was found between the CABG and PCI groups in the risk for death (12.1% vs 14.1%) or the risk for a composite of death, myocardial infarction, or cerebrovascular accident (17.5% vs 20.0%).
The rate of major adverse cardiac and cerebrovascular events was significantly lower in the CABG group than in the PCI group (21.8% vs 35.1%). The researchers explain that the difference was mainly driven by an increase in the rate of repeat revascularizations in PCI versus CABG (22.4% vs 5.1%).
“We suggest that PCI should not be offered to a patient as equivalent without the patient’s own informed choice,” Choi and colleagues comment.
“However, the encouraging safety data results for PCI support recent suggestions that PCI might be an acceptable alternative to CABG; particularly if the patient and/or physician are willing to accept the greater risk of a repeat procedure after PCI.”
The research is published in the American Journal of Cardiology.
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By Andrew Czyzewski