Lower Cerebrovascular Events, Death, MI, with DES vs. CABG in Left Main Disease   

By TCT Daily Staff
Long-term data appear to support the use of PCI instead of CABG in unprotected left main coronary artery lesions.
According to a study presented by Alaide Chieffo, MD, of San Raffaele Hospital, Milan, Italy, follow-up of at least four years in 249 patients at a single center in Milan demonstrated lower rates of in-hospital and major cardiac and cerebrovascular events (see Figure) in patients treated with DES compared with surgical intervention. The study adds updated, four-year data to previously reported results.
Results for MACCE, including repeat revascularization, appeared at first to favor CABG at four years, Chieffo said. There was a trend towards more frequent revascularization among patients treated with DES: 36% of DES patients compared with 28% in the CABG group (adjusted OR=1.44; 95% CI 0.75-2.77). However, the difference was not statistically significant (P=.30).
Although four-year differences results in MACCE were not statistically significant, a clear difference could be seen in the two intervention strategies in terms of combined cerebrovascular events, death, and MI, with results favoring the use of DES and PCI. According to Chieffo, 14% of patients in the PCI group had one of these events compared with 22% in the CABG group (adjusted OR=0.43; 0.17-0.97).

"There was a significant reduction of combined endpoints of MI, death and cerebrovascular events that was in favor of PCI as compared to CABG at four years," Chieffo said.

"At four-year clinical follow-up in this single-center experience, there was still no difference in the occurrence of MACCE between elective PCI with DES implantation and CABG in LMCA lesions," Chieffo said. "There was a significant reduction of combined endpoints of MI, death and cerebrovascular events that was in favor of PCI as compared to CABG at four years."

In a separate presentation, Pawel E. Buszman, MD, of Upper Silesian Medical Center, Poland, presented data from the LEMANS registry, a tracking system for interventions in unprotected left main coronary artery stenosis. Current guidelines strongly recommend surgical revascularization because several studies have associated stent implantation in the left main coronary artery with periprocedural risk, Buszman said.

However, recent advances in both stent technology and implantation techniques have made stenting a more popular choice among interventionalists.

Overall, the LEMANS registry showed a