Coronary artery bypass grafting generally remains superior to drug-eluting stents in left main coronary artery disease

CABG still trumps stents in left main coronary artery disease Coronary artery bypass grafting generally remains superior to drug-eluting stents in left main coronary artery disease, especially in patients with complex anatomy and multivessel disease, despite advances in stent technology, a meta-analysis by Sydney researchers has concluded. Dr Christopher Cao, from St George Hospital, and colleagues identified three randomised controlled trials and 11 observational studies which included a total of 5,628 patients. There was a higher incidence of major cardiovascular and cerebrovascular events (MACCE) at 12 months and beyond in patients receiving stents. They were also more likely to need repeat revascularisation, but less likely to have a stroke. All-cause mortality was similar in CABG and stent patients at 30 days and during follow-up beyond one year, but lower in stent patients at 12 months. Stent patients were more likely than CABG patients to have a myocardial infarction at 30 days, but the rates were similar at one year and beyond. Surgery had traditionally been regarded as superior to stenting in patients with left main disease but the situation had not been thoroughly reviewed since the use of drug-eluting stents had become widespread, the authors said. The current results suggested that drug-eluting stents “…may have an important clinical role for selected patients with percutaneously-amenable left main disease who are poor candidates for surgery,” they said. They cautioned that the results included in the meta-analysis were collected from highly selected groups of patients treated in tertiary referral centres and their outcomes might not reflect those obtained in routine care. Most patients with left main disease had multivessel coronary artery disease but they might have been under-represented in the clinical trials and more likely to have CABG in the observational studies. Longer-term follow-up of larger numbers of patients were still needed, they said. Journal of Thoracic and Cardiovascular Surgery; doi:10.1016/j.jtcvs.2012.02.004, despite advances in stent technology, a meta-analysis by Sydney researchers has concluded. Dr Christopher Cao, from St George Hospital, and colleagues identified three randomised controlled trials and 11 observational studies which included a total of 5,628 patients. There was a higher incidence of major cardiovascular and cerebrovascular events (MACCE) at 12 months and beyond in patients receiving stents. They were also more likely to need repeat revascularisation, but less likely to have a stroke. All-cause mortality was similar in CABG and stent patients at 30 days and during follow-up beyond one year, but lower in stent patients at 12 months. Stent patients were more likely than CABG patients to have a myocardial infarction at 30 days, but the rates were similar at one year and beyond. Surgery had traditionally been regarded as superior to stenting in patients with left main disease but the situation had not been thoroughly reviewed since the use of drug-eluting stents had become widespread, the authors said. The current results suggested that drug-eluting stents “…may have an important clinical role for selected patients with percutaneously-amenable left main disease who are poor candidates for surgery,” they said. They cautioned that the results included in the meta-analysis were collected from highly selected groups of patients treated in tertiary referral centres and their outcomes might not reflect those obtained in routine care. Most patients with left main disease had multivessel coronary artery disease but they might have been under-represented in the clinical trials and more likely to have CABG in the observational studies. Longer-term follow-up of larger numbers of patients were still needed, they said. Journal of Thoracic and Cardiovascular Surgery; doi:10.1016/j.jtcvs.2012.02.004

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