Equivalent safety profiles of PCI, CABG in patients with unprotected left main coronary artery stenosis
medwireNews: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have equivalent safety outcomes among patients with unprotected left main coronary artery (ULMCA) stenosis, but there are higher rates of repeat revascularization with PCI, researchers report.
In a meta-analysis of data from 4594 trial participants, the authors found no significant difference in the composite safety endpoint of all-cause death, myocardial infarction (MI), or stroke among patients undergoing PCI with drug-eluting stents (DES) versus CABG, with corresponding rates of 13.7% and 14.1% (odds ratio [OR]=0.97).
However, repeat revascularization was necessary in 14.2% of patients undergoing PCI versus 8.3% of those undergoing CABG, a significant difference (OR=1.85).
“These data imply that PCI using DES for ULMCA disease is not harmful and should be considered an acceptable revascularization option,” write Adam Brown (Monash University, Clayton, Victoria, Australia) and fellow researchers in Circulation: Cardiovascular Interventions.
“However, this does not mean that undertaking PCI for ULMCA intervention is not without risk, and suboptimal PCI results may have profound implications for the patient,” they add.
The meta-analysis included data from ULMCA patients at low surgical risk who participated in five published randomized controlled trials comparing PCI with CABG. Three of the five trials investigated PCI using early-generation DES, whereas two used newer-generation DES.
Although rates of the composite effectiveness endpoint – consisting of all-cause death, MI, stroke, and repeat revascularization – were significantly higher among patients undergoing PCI compared with CABG (23.3 vs 18.2%), the incidence of mortality, MI, and stroke was similar between revascularization strategies. This means that higher rates of repeat revascularization in those undergoing PCI “drove the secondary outcome of clinical effectiveness in favor of CABG,” explain Brown and team.
The authors note that the choice of revascularization strategy is affected by many factors, including “clinical presentation and presence of adverse medical comorbidities,” and that PCI “may be preferable” in those presenting with ST-segment elevation MI because it provides more rapid revascularization.
They conclude that “[u]ltimately, the decision on which revascularization strategy should be used rests with the patient, who should be fully informed of the risks and potential benefits of each treatment option by a multidisciplinary heart team that understands the local expertise available.”
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