Five-year mortality is similar for patients with left main coronary artery disease who undergo percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG), according to new data published in The Lancet.
Overall, 4,394 patients with left main coronary artery disease were included in the analysis. Data came from the SYNTAX, PRECOMBAT, NOBLE and EXCEL trials. All patients were randomly assigned to undergo PCI with a drug-eluting stent or CABG. Seventy-six percent of patients were men, and the median age was 66 years old.
While 25.1% of patients presented with diabetes, 74% had a distal left main lesion, 16.2% had left main disease only and another 12.3% had a left ventricular ejection fraction of less than 50%.
According to the authors, the median number of stents placed in PCI-treated patients was 2, with a median total stent length of 42.0 mm. Also, 95.6% of CABG patients received a left internal mammary artery graft, with a median of 2.0 total conduits (arterial or venous) placed, and 27.6% underwent off-pump surgery.
Overall, the rates of cardiovascular death after five years of follow-up were 6.2% among PCI patients and 5.9% among CABG patients. The rates of non-cardiovascular death were 5.2% in PCI-treated patients and 4.5% in CABG-treated patients.
“Even though the clinical indication for left main revascularization is typically to improve long-term survival, individual trials comparing revascularization strategies have been underpowered to assess this endpoint,” wrote lead author Marc S. Sabatine, MD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues. “The primary purpose of this individual patient data meta-analysis was therefore to compare all-cause deaths in patients with left main coronary artery disease treated with PCI or CABG.”
Also, the risk of stroke was similar between the two treatment options. Spontaneous myocardial infarction and repeat revascularization, meanwhile, were more likely among PCI patients.
"A heart team approach to communicate expected outcome differences might be useful to assist patients in reaching a treatment decision," the authors added.
The full study can be found here.