Coronary Angioplasty Is a Valid Alternative for Left Main Coronary Artery Disease

Courtesy of Dr. Carlos Fava.

Severe left main coronary artery (LMCA) lesions have a bad prognosis in coronary disease. In that scenario, current guidelines recommend surgery as the treatment of choice. However, due to the current development of second-generation drug-eluting stents (DES) and greater operator expertise, left main coronary artery angioplasty appears as a valid alternative in various modern randomized studies.

La ATC es una alternativa válida en el TCI

In this case, 6 studies (EXCEL, NOBLE, LE MANS, PRE COMBAT, Boudriot, and SYNTAX) including 4700 total patients were analyzed.


Read also: Burnout Syndrome among Cardiologists”.


There were no significant differences in all-cause mortality at 30 days (0.61; 95% confidence interval [CI]: 0.27 to 1.36), 1 year (0.66; 95% CI: 0.42 to 1.04), and 3 years (1.04; 95% CI: 0.81 to 1.33). However, there was a trend towards lower mortality during the first year.

 

The risk of major adverse cardiac events (MACE) at 30 days and 1 year was similar for both strategies; however, in the long term, it was higher for patients who underwent angioplasty, due to higher revascularization rates between the first and third year.

 

Patients who underwent angioplasty experienced less events of stroke at 30 days and 1 year. No difference was observed beyond that period. Conversely, the risk of acute myocardial infarction (MI) was similar at 30 days, 1 year, 3 years, and 10 years.


Read also: Clinical and Economic Costs Compete in the De-Escalation of Antiplatelet Therapy”.


The composite outcome of death, stroke and MI was lower with angioplasty at 30 days (0.67; 95% CI: 0.49 to 0.92), but similar at 1 and 3 years.

 

Conclusion

No significant differences in all-cause mortality were observed between angioplasty and myocardial revascularization surgery (MRS) in the short and the long term. Angioplasty was associated with a reduction in the risk of major cardiovascular events in the short term in patients with left main coronary artery (LMCA) stenosis, as well as with increased rates of MACE in the long term.

 

Editorial Comment

This meta-analysis of modern randomized studies shows that LMCA angioplasty is safe and offers outcomes similar to those obtained with MRS, beyond its short-term benefits.

 

While, after a year, patients who underwent angioplasty experienced more MACE events, this is mainly due to a higher need for reintervention and is in no way related to hard events such as death or stroke.

 

These results will surely improve with new stents, more technology involvement in the assessment of stent implantation, and greater cumulative operator expertise.

 

Courtesy of Dr. Carlos Fava.

 

Original title: All-Cause Mortality and Major Cardiovascular Outcomes Comparing Percutaneous Coronary Angioplasty Versus Coronary Bypass Grafting in the Treatment of Unprotected Left Main Stenosis: A Meta-Analysis of Short-Term and Long-Term Randomized Trials.

Reference: Jari A. Laukkanen, et al. Open Heart BMJ 2017;4e000638.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

RODIN-CUT: Successive Cutting Balloon Technique in Calcified Lesions

Moderate or severe coronary calcification can be a marker of poor prognosis in coronary artery disease, as it significantly increases the risk of failure...

Acute Coronary Syndrome with Multivessel Disease: Best Revascularization Strategy

The gold standard treatment for acute coronary syndrome (ACS), especially acute myocardial infarction (AMI) is primary angioplasty (PCI). However, 40 to 70% of ACS...

Improved Ejection Fraction in Chronic Total Occlusion?

Chronic total occlusions (CTO) represent a significant challenge in the current clinical practice, seeing as CTO percutaneous coronary intervention (PCI) is complex and involves...

Timing in Complete Revascularization in Acute Coronary Syndrome: BIOVASC 2-Year Followup

The concept of complete revascularization (CR) has been comprehensively studied, leading to diverse approaches and debates on optimal timing.  The BIOVASC trial explored the ideal...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

RODIN-CUT: Successive Cutting Balloon Technique in Calcified Lesions

Moderate or severe coronary calcification can be a marker of poor prognosis in coronary artery disease, as it significantly increases the risk of failure...

Acute Coronary Syndrome with Multivessel Disease: Best Revascularization Strategy

The gold standard treatment for acute coronary syndrome (ACS), especially acute myocardial infarction (AMI) is primary angioplasty (PCI). However, 40 to 70% of ACS...

Improved Ejection Fraction in Chronic Total Occlusion?

Chronic total occlusions (CTO) represent a significant challenge in the current clinical practice, seeing as CTO percutaneous coronary intervention (PCI) is complex and involves...