A comparison of treatments for left main coronary artery disease

This study aimed to compare the effectivness of coronary artery bypass grafting surgery and percutaneous coronary intervention with drug eluting stent in patients with left main coronary disease.

This study concluded there were no differences in effectiveness at 3–5 years after coronary artery bypass grafting surgery or percutaneous coronary intervention with drug eluting stent.

Coronary disease is caused by the build-up of plaque in the arteries that supply the heart with blood. The plaque narrows the arteries and restricts the blood flow. Left main coronary disease (LMCD) is a specific type of coronary disease where the left artery is affected.

Coronary artery bypass grafting (CBAG) is a type of surgery that can be used for LMCD and helps to improve blood flow. It involves connecting a healthy artery to the blocked artery so the blood has a new path and can flow around the blockage.

Percutaneous coronary intervention (PCI) can also be used for LMCD. It is a non-surgical procedure that works by inserting a stent into the blocked artery. It helps to keep it open and allows blood to flow again. Drug eluting stents (DES) are often used in PCI and prevent the artery closing again. They release drugs that prevent scar tissue.

It was not known whether CBAG or PCI with DES is more effective. 

This study used data from 5 trials that had compared CBAG and PCI with DES. The data came from a total of 4595 patients.

After 30 days, CABG patients were 2.54 times more likely to have a stroke and 45% more likely to have a heart attack during or soon after treatment when compared to PCI patients.  

After 1 year, CBAG patients were 44% less likely to have repeat revascularization but were 5.11 times more likely to have a stroke when compared to PCI patients.

After 3-5 years, CBAG patients were 45% less likely to have repeat revascularization, and 55% less likely to have a heart attack when compared to PCI patients.

This study concluded that there were no differences in death, heart attack, and stroke rates at 3–5 years after CABG or PCI. It was also concluded that CABG decreased the rate of repeat revascularization and heart attack not related to treatment.

Further studies over a longer period of time are needed. 

Consult your physician about treatment options for left main coronary disease.