▸ The PLATO trial. The Study of Platelet Inhibition and Patient Outcomes (N. Engl. J. Med. 2009;361:1045-57) trial found that ticagrelor had a significantly lower rate of death from vascular causes, heart attack, or stroke when compared with clopidogrel, with no increase in the overall bleeding rate. “It looks like we have a home run once this drug gets approved,” Dr. Sharma said.
▸ Unprotected left main coronary artery studies. The SYNTAX trial (N. Engl. J. Med. 2009;360:961-72) compared the paclitaxel-eluting Taxus stent with coronary artery bypass grafting (CABG) for atherosclerosis. While the findings confirmed CABG as the standard of care for three-vessel or left main coronary artery disease, Dr. Sharma said that PCI for left main coronary artery disease has shown steadily improving outcomes.
Updated American College of Cardiology/American Heart Association guidelines have elevated PCI for left main coronary artery disease to a class IIb indication from class III for patients at high risk of surgery, Dr. Sharma said. “But I am disappointed they did not take it into consideration for ostial left main disease,” he added. The EXCEL (Evaluation of Xience Prime Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, which began enrolling patients this year, will provide what Dr. Sharma called “the final answer” on the use of PCI in left main coronary artery disease.
Dr. Sharma has received honoraria from Boston Scientific Corp., Abbott Laboratories, and the Medicines Company.
PCI for left main coronary artery disease has shown steadily improving outcomes.
Source DR. SHARMA