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SCAI-ACC: Left Main Coronary Disease Treatments Compared

Mortality similar for stenting and coronary artery bypass grafting

MONDAY, March 31 (HealthDay News) -- In patients with left main coronary artery disease, percutaneous coronary intervention (PCI) with stenting and coronary artery bypass grafting (CABG) result in similar rates of death, though the rate of target-vessel revascularization is higher in patients treated with stenting, according to an article published online March 31 in the New England Journal of Medicine and presented at the SCAI Annual Scientific Sessions in Partnership with ACC i2 Summit (SCAI-ACCi2) in Chicago.

Ki Bae Seung, M.D., of Catholic University of Korea in Seoul, and colleagues used propensity-score matching to compare adverse outcomes in 1,102 patients with unprotected left main coronary artery disease who underwent stent placement and in 1,138 patients who underwent CABG.

In the overall matched cohort, the risk of death or of the composite outcome (death, Q-wave myocardial infarction or stroke) did not differ between the stenting and CABG groups, the investigators found. However, rates of target-vessel revascularization were significantly higher in the group treated with stenting (hazard ratio 4.76), a benefit that persisted even when drug-eluting stents and bare-metal stents were compared separately.

In this study, "CABG was still more effective than drug-eluting stents in reducing the need for target-vessel revascularization," write the authors. "However, there was a significantly higher rate of follow-up angiography in the PCI group than in the CABG group (73 percent versus 14.6 percent). Therefore, the rate of asymptomatic graft stenosis or occlusion may have been underestimated in the CABG group relative to the PCI group."

Several of the study co-authors report financial relationships with pharmaceutical and medical technology firms.

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