Is angioplasty as safe as coronary artery bypass grafting?

This study compared percutaneous coronary intervention (PCI) using drug-eluting stents (DES) to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). The study concluded that PCI was associated with a higher risk needing another procedure and heart attacks, but not of death or stroke.

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 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 coronary artery supplies blood to most of the heart. CABG was formerly considered the main treatment for people with LMCAD. However, newer research suggests PCI with drug-eluting stents may be just as effective. However, the safety and effectiveness of PCI with drug-eluting stents , compared with CABG, for LMCAD remains unclear.

This study examined data from 12 other studies. 10,284 people with LMCAD were included. 5,017 (48.2%) had PCI with drug-eluting stents. 5,267 (51.2%) had CABG. They were followed up for between 3 and 7.2 years, depending on the study.

There was no significant difference between the two groups in terms of mortality or stroke rates. The PCI group was 2.74 times more likely to need another procedure, and 63% more likely to have a heart attack after 3 years or more. The risks were higher in people in the PCI group with more complicated LMCAD. In people with less complicated LMCAD, the risks were the same for both groups.

This study concluded that PCI with drug-eluting stents is associated with a higher risk of heart attack and the need for another procedure than CABG in people with complicated LMCAD, but is as effective in patients with less complicated LMCAD.

Differences between the studies may have made comparisons difficult. Many of the studies used older drug-eluting stents, which are more likely to cause another procedure to be needed.

Discuss the advantages and disadvantages of PCI and CABG with your physician.