A review of 5-year outcomes after PCI or CABG intervention for left main coronary disease

This study investigated outcomes after 2 surgical interventions to treat coronary artery disease (CAD) in the left main artery.

They found no difference in outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in these patients. 

Coronary artery disease (CAD) is caused by blockages in the coronary arteries. This reduces blood supply to the heart. It can lead to major cardiac events including heart attack, stroke, and death. Surgery is used to restore blood flow. Percutaneous coronary intervention (PCI) is a surgical procedure. It removes the blockage and a stent is sometimes placed in the vessel to keep it open. Some stents are coated in a drug to prevent blood clotting. These are called drug-eluting stents (DES). 

Coronary artery bypass graft (CABG) is another surgical option. It is more invasive than PCI. It involves using a graft vessel to bypass the blockage in the artery. PCI is more attractive because it is less invasive. Studies show that the short-term outcomes with PCI are similar to CABG. It is unclear if the long-term outcomes of PCI and CABG are similar in patients with CAD in the left main artery (LMA). 

This study included 1905 patients with CAD in the LMA. Patients were randomly assigned to PCI (948 patients) or CABG (957 patients). The primary outcome events included the rates of death from any cause, stroke or heart attack. Patients were followed up for 5 years.

After 5 years, the rates of death, stroke or heart attack were 22% in the PCI and  19.2% in the CABG groups. Death rates from any cause were higher in PCI versus CABG-treated patients (13% vs. 9.9%).

However, the rates of heart-related death were similar in both groups (5%-PCI vs 4.5%-CABG). Heart attack and stroke rates were also similar between groups. Brain events (a stroke or transient ischemic attack; TIA) were more common after CABG compared to PCI (5.2% vs. 3.3%). A TIA is caused by reduced blood flow to the brain for a very short period of time. 

The authors concluded there was no difference in death, heart attack or stroke after PCI or CABG in patients with LMA disease.