Randomized Comparison of Percutaneous Coronary Intervention With Sirolimus-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Stem Stenosis
| Autor: | Thomas Zietak, Tilmann Pohl, Harald Mudra, Thomas Walther, Christoph Liebetrau, Bruno Reichart, Peter Boeckstegers, Holger Thiele, Gerhard Schuler, Florian Beier, Friedrich-Wilhelm Mohr, Enno Boudriot, Michael Gick, Brigitte Gansera, Franz-Josef Neumann, Steffen Desch |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Revascularization law.invention Coronary Restenosis surgery Coronary artery disease Randomized controlled trial law Internal medicine medicine Clinical endpoint Humans Prospective Studies cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Coronary Artery Bypass Aged Sirolimus business.industry Coronary Stenosis Percutaneous coronary intervention Drug-Eluting Stents Middle Aged equipment and supplies medicine.disease Coronary Vessels Surgery Radiography Stenosis Treatment Outcome surgical procedures operative stents Conventional PCI Cardiology Female revascularization Cardiology and Cardiovascular Medicine business left main stem coronary artery disease Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 57:538-545 |
| ISSN: | 0735-1097 0017-6397 |
| DOI: | 10.1016/j.jacc.2010.09.038 |
| Popis: | ObjectivesThe purpose of this randomized study was to compare sirolimus-eluting stenting with coronary artery bypass grafting (CABG) for patients with unprotected left main (ULM) coronary artery disease.BackgroundCABG is considered the standard of care for treatment of ULM. Improvements in percutaneous coronary intervention (PCI) with use of drug-eluting stents might lead to similar results. The effectiveness of drug-eluting stenting versus surgery has not been established in a randomized trial.MethodsIn this prospective, multicenter, randomized trial, 201 patients with ULM disease were randomly assigned to undergo sirolimus-eluting stenting (n = 100) or CABG using predominantly arterial grafts (n = 101). The primary clinical end point was noninferiority in freedom from major adverse cardiac events, such as cardiac death, myocardial infarction, and the need for target vessel revascularization within 12 months.ResultsThe combined primary end point was reached in 13.9% of patients after surgery, as opposed to 19.0% after PCI (p = 0.19 for noninferiority). The combined rates for death and myocardial infarction were comparable (surgery, 7.9% vs. stenting, 5.0%; noninferiority p < 0.001), but stenting was inferior to surgery for repeat revascularization (5.9% vs. 14.0%; noninferiority p = 0.35). Perioperative complications including 2 strokes were higher after surgery (4% vs. 30%; p < 0.001). Freedom from angina was similar between groups (p = 0.33).ConclusionsIn patients with ULM stenosis, PCI with sirolimus-eluting stents is inferior to CABG at 12-month follow-up with respect to freedom from major adverse cardiac events, which is mainly influenced by repeated revascularization, whereas for hard end points, PCI results are favorable. A longer follow-up is warranted. (Percutaneous Coronary Intervention [PCI] With Drug-Eluting Stents [DES] Versus Coronary Artery Bypass Graft [CABG] for Patients With Significant Left Main Stenosis; NCT00176397) |
| Databáze: | OpenAIRE |
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