News | March 31, 2008

Study Finds Support for PCI in Unprotected Left Main Disease

April 1, 2008 - Percutaneous coronary intervention (PCI) may be a reasonable alternative to bypass surgery in patients with blockages in the left main coronary artery, according to a study that found no significant difference in rates of survival when stents and bypass surgery were used to restore blood flow through this critically important artery.

Patients who were treated with stenting were more likely to need a repeat procedure to keep the artery open, however.

The findings come from the Revascularization for Unprotected Left MAIN Coronary Artery Stenosis: COMparison of Percutaneous Coronary Angioplasty Versus Surgical REvascularization (MAIN- COMPARE) study, which drew its data from a large multicenter data registry in Korea, where left-main stenting is far more common than in the U.S.

The study was reported yesterday in a Late-Breaking Clinical Trials session at the SCAI Annual Scientific Sessions in Partnership with ACC i2 Summit (SCAI-ACCi2) in Chicago. SCAI-ACCi2 is a scientific meeting for practicing cardiovascular interventionalists sponsored by the Society for Cardiovascular Angiography and Interventions (SCAI) in partnership with the American College of Cardiology (ACC). This study will simultaneously publish in The New England Journal of Medicine.

The left-main coronary artery supplies blood to approximately 75 percent of the left ventricle. When a blockage is located in the left main coronary artery, coronary artery bypass surgery (CABG) is usually considered the safest procedure, unless the patient is protected by an existing bypass graft that routes blood to another major coronary artery supplying the left side of the heart.

The new study suggests it is worth considering stent implantation even if the left main coronary artery is unprotected by a prior bypass graft. "Because the recommendation for surgery for left main disease is based mostly on survival benefit, the lack of a statistically significant difference in mortality may support PCI as an alternative option to bypass surgery," said Seung-Jung Park, M.D., Ph.D., director of interventional cardiology at Asan Medical Center, Seoul, Korea. "It is also worth noting that most of patients treated with drug-eluting stents who need target vessel revascularization can be treated with subsequent PCI, without significant increase of death or serious complications."

For the study, Dr. Park and his colleagues analyzed data from 2,240 patients with unprotected left main coronary artery disease treated at 12 medical centers in Korea. Of these, 318 were treated with bare-metal stents, 784 were treated with drug-eluting stents, and 1,138 underwent bypass surgery. During three years of follow-up, patients treated with bare-metal stents were nearly 11 times as likely to need a repeat procedure to reopen the target vessel when compared to those who underwent bypass surgery.

However, the rates of death (hazard ratio: 1.04) and the combined rates of death, heart attack and stroke (hazard ratio: 0.86) were similar in the two groups. Patients treated with drug-eluting stents were nearly six times as likely to need a repeat procedure during three years of follow-up, but the rates of death (hazard ratio 1.36) and the combined rates of death, heart attack and stroke (hazard ratio: 1.40) were statistically similar, although there was a trend toward higher event rates with drug-eluting stents.

The next step is to test the study's findings in a more rigorous clinical trial, Dr. Park said. "Based on these observations, a randomized trial comparing PCI with drug-eluting stents and CABG is warranted in patients with unprotected left main disease who are candidates for revascularization," he said. "However, unprotected left main stenting should not be attempted in clinical practice before the physician has achieved specialized experiences."

For more information: www.scai-acci2.org

Related Content

The Biotronik Osiro is an ultra thin strut, sirolimus-eluting stent. #TCT2018

The Biotronik Osiro is an ultra thin strut, sirolimus-eluting stent.

News | Stents | October 04, 2018
October 4, 2018 – Investigators unveiled clinical data from the independent BIONYX and SORT OUT IX all-comers trials
FDA Approves Biotronik's PK Papyrus Stent for Coronary Perforations
Technology | Stents | September 27, 2018
September 27, 2018 — Biotronik recently announced U.S.
Videos | Stents | September 11, 2018
This is an animation showing how the dedicated bifurcation stent developed by Advanced Bifurcation Systems (ABS) is d
Elixir Medical Corporation Unveils Transformational DynamX Stent Featuring Adaptive Segments that Uncage the Stented Artery
News | Stents | January 25, 2018
January 25, 2018 – Elixir Medical Corporation, a leader in the development of breakthrough adaptive remodeling techno
The TIDES-ACS results show us that the Optimax stent is noninferior in patients with acute coronary syndrome compared to Synergy.

The presentation of the ESC late-breaker TIDES-ACS results show us that the Optimax stent is noninferior in patients with acute coronary syndrome compared to Synergy.

News | Stents | November 24, 2017
November 24, 2017 – During a late-breaking session at the European Society of Cardiology (ESC) 2017 meeting, presente
News | Stents | November 10, 2017
Cordis, a Cardinal Health company, recently unveiled a comprehensive interventional cardiology portfolio, which now...
OCT comparison between the Combo vs. Xience stents in the HARMONEE study.

OCT comparison between the Combo vs. Xience stents in the HARMONEE study.

Feature | Stents | November 08, 2017
November 8, 2017 – New results from the HARMONEE Japan/U.S.
FDA Approves COBRA REDUCE Trial of 14-Day DAPT With CeloNova Stent
News | Stents | October 27, 2017
CeloNova BioSciences Inc. announced the U.S. Food and Drug Administration (FDA) approved expansion of CeloNova's...
CeloNova Cobra Pzf stent
Technology | Stents | March 02, 2017
March 2, 2017 — The U.S. Food and Drug Administration (FDA) cleared CeloNova BioSciences Inc.
OCT, intravascular imaging, stent, good stent apposition on vessel wall, TRANSFORM-OCT study

An OCT image showing good stent strut apposition against the vessel wall.

News | Stents | January 13, 2017
January 13, 2017 — Results from TRANSFORM-OCT, a prospective, randomized trial using optical coherence tomography (OC
Overlay Init