Comparing the effectiveness and safety of percutaneous coronary intervention versus coronary artery bypass grafting in patients with left main coronary artery disease.

This study compared the effectiveness and safety of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) in patients with left main (LM) coronary artery disease (CAD). The data showed that both treatments were associated with a similar risk of heart attack, stroke, and death. PCI significantly increased the risk of unplanned revascularization compared to CABG in these patients.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This reduces the blood flow to the heart and can lead to a heart attack. PCI (or angioplasty) is a non-surgical procedure where narrow or blocked arteries are widened or unblocked. In some cases, a stent is implanted. A stent is a flexible tube that keeps the artery open. Drug-eluting stents (DES) also release medication into the body. These drugs prevent cells from gathering inside the stent and blocking it again.

CABG is a surgical procedure where a healthy blood vessel is taken (usually from the chest wall). This healthy vessel will be connected (‘grafted’) to the blocked artery. This creates a ‘bypass’ around the blocked artery. The left main (LM) coronary artery supplies blood to most of the heart. CABG was formerly considered the main treatment for people with LMCAD. Newer research suggests that PCI with drug-eluting stents may be just as effective. However, the effectiveness and safety of PCI with DES compared with CABG in patients with LMCAD remain unclear.

This study analyzed 5 other studies and involved a total of 4595 patients with LMCAD. Patients were randomly assigned into 2 groups. Group 1 included 2297 patients who received PCI. Group 2 included 2298 patients who received CABG. Patients were followed-up for between 1 and 10 years.

After 10 years, the mortality rate for group 1 was 12% and for group 2 was 10.6%. This difference was not statistically significant. There was also no significant difference between the two groups in terms of heart attack or stroke rates.

15.1% of patients in group 1 needed unplanned revascularization (restoring the delivery of the blood to the heart) compared to 8% in group 2. Patients who received PCI treatment were 1.8 times more likely to have unplanned revascularization compared to CABG treatment.

This study concluded that both PCI and CABG were associated with a similar risk of heart attack, stroke, and death in patients with LMCAD. However, PCI significantly increased the risk of unplanned revascularization compared to CABG in these patients.

This study did not evaluate risks of reoperation for bleeding, atrial fibrillation (irregular heart rhythm), prolonged hospital stay, complications of the surgery, or patient factors like frailty.