DES, CABG Comparable for Death, MI in Left Main Disease 

DES,CABG对于左主干治疗其死亡、心梗发生率具有可比性

DES, CABG Comparable for Death, MI in Left Main Disease 

By TCT Daily Staff

Left main interventional treatment with DES had comparable clinical outcomes to CABG in hard endpoints that included mortality and MI, but possibly higher rates of TLR and TVR, according to data presented by Seung-Jung Park, MD, PhD, from the Asan Medical Center at the University of Ulsan in Seoul, South Korea.

Park and colleagues enrolled a registry of 147 patients (60 high-risk patients and 87 low-risk patients) who had undergone left main interventional treatment. Patients were followed for an average of 886 days. During the follow-up period, there were four cardiac deaths among the high-risk patients and no cardiac deaths among the low-risk patients.

Park said research has demonstrated the benefits of left main interventional treatment but four issues regarding this treatment remain: ostial and shaft lesions, distal bifurcation lesions, IVUS-guided procedures, and stenting vs. CABG. Park’s research examined each of these issues.

Ostial, shaft lesions

Park said the registry data demonstrated low mortality, TLR, and TVR rates: At three-year follow-up, there were four cardiac deaths, one TLR, and seven TVR procedures. The registry data also indicated a low rate of late stent thrombosis at the three-year follow-up mark.

"These findings suggest that ostial and shaft left main stenting would be acceptable for clinical practice," Park said.

Distal bifurcation

Park and his colleagues also examined distal bifurcation left main stenting. "The present results suggest that DES implantation in unprotected left main coronary artery bifurcation stenoses is safe and effective," Park said.

"Compared with complex stentings, single stenting was technically easier and appeared to be more effective in improving long-term outcomes for lesions with normal left circumflex." In cases with diseased left circumflex, both kissing stenting and the crushing technique were feasible with acceptable long-term outcomes, according to Park.

IVUS-guided procedures

Registry data indicated that IVUS-guided DES procedures were associated with lower mortality rates than angiography-guided procedures (4.4% vs. 16%; P=.048). IVUS-guided bare-metal stent procedures were associated with numerically lower mortality rates than angiography-guided bare-metal procedures, although the difference was not statistically significant (8.6% vs. 10.8%; P=.346).

Park said these findings indicate that IVUS guidance should be mandatory in left main stenting with DES.

Stenting vs. CABG

Several studies have compared the outcomes of stenting vs. CABG. Park referred to recent research from Chieffo et al indicating that mortality and MI rates were numerically lower after one year among patients treated with DES than among those treated with CABG, although the differences were not statistically significant (see Figure).

However, according to the same data, the rates of TLR and TVR were higher among patients treated with DES than among those treated with CABG.

Park noted that other research has shown similar results. "Data from registry and randomized clinical trials clearly suggest that PCI with a DES has a comparable clinical outcome with CABG in hard end points but [is associated with] higher target revascularization rates," Park said.

SYNTAX trial results

Marie-Claude Morice, MD, from the Institut Jacques Cartier in Massy, France, presented results from the SYNTAX trial on Monday.

In SYNTAX, the rate of major adverse cardiovascular events at one year was similar between patients treated with PCI (15.8%) and those treated with CABG (13.7%), Morice said.

The run-in phase of the SYNTAX trial included arms in Europe and North America. In Europe, the trial included 1,867 patients treated with CABG and 648 patients treated with PCI. In North America, the trial included 813 patients treated with CABG and 212 patients treated with PCI.

According to Morice, the SYNTAX results also demonstrated positive outcomes after stenting in patients with isolated left main or left main and single-vessel disease.

However, for patients with left main and two- or three-vessel disease, physicians should consider treatment with CABG, Morice said.

Disclosures:

Dr. Park reports no relevant conflicts of interest.
Dr. Morice reports no relevant conflicts of interest.

（source：www.tctmd.com）