In a nutshell
This study aimed to compare percutaneous coronary intervention and coronary artery bypass graft surgery for revascularization in left main coronary artery disease.
This study concluded that percutaneous coronary artery intervention could be a safer method of revascularization in left main coronary artery disease.
Some background
Left main coronary artery disease (CAD) involves plaque build-up in the arteries of the left-hand side of the heart. CAD interferes with blood flow to the heart. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are methods used to treat CAD by revascularization. Revascularization restores delivery of the blood to the heart.
PCI involves treating the narrowing of blood vessels. It is a non-surgical method that uses tubes called stents to keep the blood vessels open. There are different types of stents. CABG surgery involves attaching new blood vessels to the coronary arteries. Blood flow can then bypass the blocked area of the artery. This method often involves open heart surgery.
It was unknown which method had better outcomes for patients with left main CAD.
Methods & findings
The findings of 28 studies were used to extract information about PCI and CABG surgery in left main CAD patients. The studies included 22,487 patients.
CAD patients treated with PCI were 69% more likely to suffer a heart attack and were 2.8 times more likely to need revascularization than CAD patients treated with CABG surgery. Patients treated with PCI were 42% more likely to suffer from heart related events and stroke.
The increased risk of heart attack was seen in PCI patients who had bare metal stents or early-generation drug-eluting stents (DES), but not those with newer generation DES.
The risk of death from all causes, heart-related death and stroke were similar for CAD patients in both the PCI and CABG groups.
The bottom line
This study concluded that PCI with newer generation DES is the safer revascularization option for left main CAD patients. However, this option leads to more repeat revascularizations.
The fine print
Further studies are needed to confirm these findings.
What’s next?
Discuss revascularization options with your physician.
Published By :
BMC Medicine
Date :
Apr 21, 2017
