Original Title: Left main stenting in Comparison with Surgical Revascularization 10-year outcomes of the (Left Main Coronary Stenting) LE MANS trial. Reference: Buszman P et al. J Am CollCardiolIntv. 2016;9(4):318-327. doi:10.1016/j.jcin.2015.10.044.
Courtesy of Dr. Guillermo Migliaro.
Long term outcomes of left main stenting are unknown. This study reports 10 year follow up outcomes of the LEMANS trial patients. The LEMANS, a prospective, multicenter and randomized trial, included 105 patients with left main stenosis randomized to PCI with stenting (n=52) vs. myocardial revascularization surgery (CABG) (n=53).
First generation drug eluting stents were used in 35% of patients and graft to the left anterior descending artery in 73%. Patients had low to medium disease complexity, with an average Syntax score of 25 (even though there was no measure at the time of randomization) and an average EuroSCORE of 3.3. Patients were followed up 9.8±1 years.
At year 10, there was a tendency (though not significant) to higher ejection fraction (this was the primary end point for the first year follow up) in the PCI group (54.9±8.3% vs 49.8±10.3% p=0.07). Mortality (21.6 vs 30.2%; p=0.41) and MACCE (51.1 vs64.4%; p=0.28) were not statistically significant, despite a difference in number in favor of PCI.
Neither were there significant differences in MI (8.7 vs 10.4% p=0.62), stroke (4.3 vs 6.3% p=0.62) or repeat revascularization rates incidence (74.2 vs 67.5% p=0.34). Survival rate at 14 years was similar in both groups (74.2 vs 67.5% p=0.34) as well as MACCE-free survival rate(34.7 vs 22.1% p=0.06). Angina functional class was low and comparable in both groups (1.7±0.9 vs 1.59±0.8)
Conclusion
In patients with left main stenosis with low to medium coexisting disease complexity, PCI has safe and effective outcomes comparable to those of CABG at very long term and, therefore, constitutes a valid alternative for these group of patients.
Editorial Comment
This is the first randomized study to compare both strategies and, at present, the first to show 10 year outcomes, which brings a unique and valuable contribution to the medical community.
This trial included few patients and has low statistical power to assess mortality.
It used a low number of DES and these were first generation.Artery grafts were also few in the CABG group.
The outcomes obtained in this study match those reported by larger studies (Syntax andPrecombat), though they extend to 5 year follow up periods.
We look forward to larger multicenter studies with second generation DES.
Courtesy of Dr. Guillermo Migliaro.