Stenting vs. CABG: Long-term outcomes similar among patients with left main CAD

Five-year risk for death, Q-wave MI and stroke were similar among patients with left main coronary artery disease who underwent stenting and those who received CABG; however, target vessel revascularization occurred more often with stenting, according to results from the MAIN-COMPARE registry.

“The present study extends previous findings to a longer-term follow-up and demonstrates that overall findings were unchanged between three and five years of follow-up,” the researchers wrote.

They evaluated 2,240 patients with left main CAD who received either coronary stents (n=1,102; 318 bare metal, 784 drug-eluting) or who underwent CABG (n=1,138) between 2000 and 2006 and for whom at least three to nine years of follow-up data were available.

After adjusting for baseline risk factors, the researchers determined the HR for five-year death risk was 1.13 (95% CI, 0.88-1.44) and the HR for combined death, Q-wave MI or stroke was 1.07 (95% CI, 0.84-1.37). Results were similar when the researchers compared bare metal vs. drug-eluting stents with concurrent CABG. Patients in the stenting group had a higher risk for target vessel revascularization vs. those in the CABG group (HR=5.11; 95% CI, 3.52-7.42).

“A large randomized comparison study with CABG will provide more confidence in the long-term safety, durability and efficacy of percutaneous coronary intervention with drug-eluting stents,” the researchers wrote.

Park DW. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.04.004.

The results are consistent with what we see in most contemporary comparisons of PCI vs. CABG across a variety of complex anatomical subsets. In patients who are candidates for PCI, with respect to “hard” outcomes, the results are as good as CABG. There remains, however, an excess of repeat procedures with PCI.

– Deepak L. Bhatt, MD

Cardiology Today Editorial Board

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