ANGIOPLASTY WITH CORONARY STENTING MAY BE ALTERNATIVE TO BYPASS SURGERY

Angioplasty with coronary drug-eluting stenting may be a viable alternative treatment to more complicated bypass surgery for patients with left main coronary artery (LMCA), according to a new study conducted at Cedars-Sinai Medical Center.

The study compared short- and intermediate-term clinical outcomes of 123 patients who underwent bypass surgery and 50 who were treated medically with angioplasty and drug-eluting stents. Patients treated with bypass surgery had longer hospitalizations and, after one month, had a higher percentage of strokes, but there was no statistically significant difference in mortality or myocardial infarction. Six months after treatment, there had been seven deaths in the bypass surgery group and two in the group treated medically.

"Despite the greater percentage of high risk patients in the group who underwent coronary stenting, there was no increase in the immediate or medium-term complications compared with the group treated with bypass surgery," said Principal Investigator Raj Makkar. According to Makkar, this is one of the first studies in the U.S. on the use of medicated stents for treating LMCA disease, which is found in approximately 6 percent of patients who undergo angiography.

"The most important finding in this study is that, in a pilot experience with unprotected (no prior CABG surgery) LMCA disease, treatment with drug-eluting stents resulted in outcomes at least equivalent to bypass surgery ," said P. K. Shah, director of the cardiology division at Cedars-Sinai. "At present, however, it is not known whether the improved outcomes in the drug-eluting stent group will be extended to all patients with LMCA disease. The results suggest a randomized comparison between the two revascularization strategies may be warranted."