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PCI, CABG may both be options in left main disease
Similar rates of MACCE were reported for PCI and CABG in a cohort of individuals with unprotected left main disease, concluded recent findings.
The researchers noted that the recommended treatment for significant de novo left main stenosis is CABG, but that a class IIa indication has been given for PCI in select patients with unprotected disease. The current analysis was an investigation of 5-year outcomes for these two approaches among 1,800 patients with left main or three-vessel disease in the SYNTAX trial. Patients in the PCI group received Taxus Express paclitaxel-eluting stents (Boston Scientific).
There were 705 patients in the unprotected left main cohort.
At 5 years, the MACCE rate was 36.9% in the PCI group and 31% for CABG (HR=1.23; 0.95-1.59). The mortality rate at this point was 12.8% for PCI and 14.6% for CABG (HR=0.88; 0.58-1.32).
PCI yielded a stroke incidence rate of 1.5% compared with 4.3% for CABG, which the researchers noted was a significant difference (HR=0.33; 0.12-0.92). Repeat revascularization was significantly higher in the PCI arm compared with CABG (26.7% vs. 15.5%; HR=1.82; 1.28-2.57).
Among individuals with low or intermediate SYNTAX scores, MACCE rates did not differ between the two groups. However, MACCE was increased in those with high scores (≥33) in the PCI group.
“At 5 years, no difference in overall MACCE was found between treatment groups,” the researchers concluded. “These results suggest that both treatments are valid options for [left main] patients. The extent of disease should [be] accounted for when choosing between surgery and PCI, as patients with high SYNTAX scores seem to benefit more from surgery compared to the lower [tertiles].”
Disclosure: The researchers report financial disclosures with Abbott and Boston Scientific.