A long-term Korean study found stents as safe as open heart surgery in treating blockages of a coronary artery known as the widowmaker, showing that stented patients did not run a significantly higher risk of suffering a heart attack or stroke.
But patients who underwent percutaneous coronary intervention, or angioplasty, with sirolimus-eluting stents were more likely to require revascularization than patients given coronary artery bypass grafts.
The randomized study, sponsored by Korea’s Cardiovascular Research Foundation, tracked approximately 600 cardiac patients for 5 years after they underwent either stenting or CABG for treatment of left main coronary artery disease. Patients in the stent cohort were treated with Johnson & Johnson’s (NYSE:JNJ) Cypher sirolimus-eluting stent.
Five-year results from the Precombat study were published last month in the Journal of the American College of Cardiology.
The study showed that 17.5% of PCI patients experienced a major adverse cardiac or cerebrovascular event within 5 years, compared with 14.3% of CABG patients. The rate of death, stroke or heart attack was 8.4% for the PCI group versus 9.6% for CABG patients.
Stent recipients had a significantly higher rate of revascularization. The rate of ischemia-driven target vessel revascularization was 11.4% for stent recipients versus 5.5% for the CABG group.
“During 5-year follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution,” the researchers wrote.
Data from the study were presented last month during a scientific session at the American College of Cardiology’s annual meeting.
“It’s an impressive study in terms of completeness of follow-up [and excellence of the operators] and shows that … left main stenting does have quite similar outcomes to bypass surgery,” the session’s moderator, Dr. John Carroll, told heartwire. “However, it doesn’t help us decide in an individual patient which is the best route to go, [and] the surgical group may not have had the same intensity of medical therapy.”
