PCI with DES ‘potential alternative to CABG’ in unprotected left main disease
MedWire News: Percutaneous coronary intervention (PCI) and coronary stenting with drug-eluting stents (DES) could represent a good alternative to coronary artery bypass graft (CABG) surgery in selected patients with unprotected left main coronary artery (ULMCA) disease, conclude researchers.
They found no difference in the risk for death and the composite endpoint of death, myocardial infarction (MI), or stroke at 1 year in a meta-analysis of studies comparing PCI with DES and CABG in ULMCA disease.
Currently, CABG is recommended for patients with ULMCA disease on the basis of a survival benefit in comparison with medical therapy, with PCI reserved for those who are poor candidates for CABG, explain Michael Lee (University of California, Los Angeles, USA) and colleagues.
DES reduce the rate of target vessel revascularization compared with bare-metal stents in PCI performed in patients with ULMCA disease, however, and “may be a safe alternative to CABG,” they reason.
To examine this, the researchers analyzed eight clinical studies comparing CABG and PCI with DES in a total of 2905 such patients; two of the trials were randomized while six were nonrandomized.
The odds ratio for death in the CABG versus DES group at 1 year was a nonsignificant 1.12; for the composite of death, MI, or stroke it was again nonsignificant, at 1.25.
The risk for target vessel revascularization was significantly lower in the CABG versus DES group, however, at an odds ratio of 0.44.
Although the authors conclude that overall the results “demonstrate that PCI with DES for ULMCA disease may be a safe alternative to CABG,” they caution that CABG is associated with increased early mortality due to perioperative complications, and so may prove to be associated with an improved long-term survival rate compared with PCI.
Furthermore, the studies included did not all mandate follow-up angiography so true restenosis and graft occlusion rates are not known, they note.
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By Caroline Price