Cardiac Stents and Bypass Surgery Are Equally Safe and Effective

Drug-eluting stents are as effective as coronary-artery bypass grafting (CABG) surgery for many patients with left main coronary artery disease (LMCAD), according to a new study.

Researchers at Columbia University Medical Center (CUMC; New York, NY, USA), the Medical University of Silesia (Katowice, Poland), and other institutions conducted a study of 1,905 patients with LMCAD who were randomized to receive an Abbott Vascular (Santa Clara, CA, USA) Xience everolimus drug eluting stent (DES), or undergo CABG. The primary end point was a composite of death from any cause, stroke, or myocardial infarction (MI) at three years. The researchers also analyzed data during the first 30 days, when serious complications are most likely to occur.

The results showed that within the short 30-day period, stent patients had a significantly lower incidence (4.9%) of death, stroke, MI, or revascularization than those who underwent CABG (7.9%). In addition, fewer stent patients had major bleeding, infections, kidney failure, or severe abnormal heart rhythms compared to those treated with surgery. But over the three-year period, the primary end-point event had occurred in 15.4% of the patients in the stent group and in 14.7% of the CABG group patients. The study was published on October 31, 2016, in the New England Journal of Medicine (NEJM).

“Our study has shown that many patients with left main coronary artery disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as bypass surgery for at least 3 years, and is initially safer, with fewer complications from the procedure," said lead author Professor Gregg Stone, MD, of CUMC. “While bypass is still considered a more durable repair, patients and doctors may prefer a percutaneous treatment approach, which is associated with better upfront results, fewer complications, and quicker recovery.”

CABG has long been considered the definitive treatment for patients with LMCAD, which affects a large portion of the heart muscle. Previous trials suggested that the first-generation DES, which release antiproliferative medications to prevent the artery from becoming re-occluded after stent placement, might be appropriate in LMCAD patients without extensive blockages in the remaining cardiac arteries.

Related Links:
Columbia University Medical Center
Medical University of Silesia
Abbott Vascular