After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few patients. As a consequence, it lacks the statistical power to generate definitive conclusions.
The PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) study randomized 300 patients to angioplasty with a sirolimus-eluting stent and another 300 patients to surgery, to treat left main coronary artery disease in 13 Korean hospitals between 2004 and 2009.
The follow-up was extended to 10 years for all patients, with a mean of 11.3.
After this incredibly long period, the primary composite endpoint of death, infarction, stroke, or target vessel revascularization occurred in 29.8% of patients in the angioplasty arm and 24.7% of patients in the surgery arm (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 0.93-1.69).
Read also: Virtual ACC 2020 | Controversial Trial ISCHEMIA Finally in NEJM.
The outcomes are practically identical between strategies once revascularization is excluded (18.2% vs. 17.5%; HR: 1.00; 95% CI: 0.70 to 1.44).
All-cause death rates were also quite similar (14.5% vs. 13.8%).
The only variable differentiating both strategies at 10 years is, as expected, target vessel revascularization (16.1% vs. 8.0%).
Conclusion
The 10-year follow-up of pioneer study PRECOMBAT shows us similar rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery lesions randomized to angioplasty or surgery.
Original Title: Ten-Year Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease. Extended Follow-Up of the PRECOMBAT Trial.
Reference: Duk-Woo Park et al. Circulation 2020; Epub ahead of print y presentado en forma virtual en el ACC 2020.
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