PCI vs CABG outcomes for left main coronary disease

Editor's Note

In this study of patients with left main coronary disease, there was no significant difference in outcomes at 5 years between treatment with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Researchers randomly assigned 1,905 patients with left main coronary artery disease of low or intermediate anatomical complexity to treatment with PCI (948 patients) or CABG (957 patients).

At 5 years:

• 22% of PCI patients and 19.2% of CABG patients had experienced a primary outcome event (ie, death, stroke, or myocardial infarction).
• Death from any cause occurred more frequently in the PCI group (13%) than the CABG group (9.9%).
• Incidence of cardiovascular death (5%, PCI vs 4.5%, CABG) and myocardial infarction (10.6%, PCI vs 9.1%, CABG) were not significantly different.
• Cerebrovascular events were less frequent after PCI (3.3%) than CABG (5.2%); however, the incidence of stroke was not significantly different between the two groups (PCI 2.9% vs CABG 3.7%).
• Revascularization was more frequent after PCI (16.9%) than CABG (10%).

Before this study, long-term outcomes after PCI and CABG in these patients had not been clearly established. Ten-year follow-up is needed, however, to characterize very late safety profiles of these procedures because both stents and bypass grafts fail over time, the researchers say.