Comparing treatment methods for non-ST elevation acute coronary syndrome

This study aimed to compare the outcomes of coronary artery bypass grafting and percutaneous coronary intervention with drug eluting stents in patients with non-ST elevation acute coronary syndrome.

This study concluded that non-ST elevation acute coronary syndrome patients treated with coronary artery bypass grafting had better outcomes than those treated with percutaneous coronary syndrome with drug eluting stents. 

Non-ST elevation acute coronary syndrome (NSTE-ACS) occurs when there is a partially blocked artery in the heart and the blood flow to the heart stops and chest pains occur.

Common treatment options for NSTE-ACS include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug eluting stents (DES). CABG is a surgery used to improve blood flow to the heart. A healthy artery is connected to the blocked artery to create a new path for blood to flow to the heart. PCI with DES is a non-surgical procedure that involves placing a structure called a stent to open the blocked artery. A drug eluting stent opens the artery and contains a drug to prevent the body rejecting the stent.

It was unknown if these two treatments had comparable long-term outcomes in NSTE-ACS patients. 

This study involved 1246 patients who had NSTE-ACS for left main or multi-vessel coronary artery disease. The main outcome investigated was death from any cause, heart attack or stroke. One group received CABG and the other received PCI with DES. Patients were followed for 60 months.

The CABG group were 26% less likely to experience the main outcome when compared to the PCI group. The CABG group was 50% less likely to have a heart attack when compared to the PCI group.

The CABG group was 44% less likely to need repeat treatment when compared to the PCI group.  

This study concluded that NSTE-ACS patients who were treated with CABG had reduced risk of death from any cause, heart attack and stroke when compared to patients treated with PCI with DES.

A larger study needs to be carried out. 

Consult your physician about the pros and cons of CABG and PCI with DES.