Percutaneous coronary intervention with a sirolimus-eluting stent showed comparable rates of death, myocardial infarction and stroke to coronary artery bypass grafting in patients with coronary artery stenosis after 5 years in a randomized trial.
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 trial in 600 patients with unprotected left main coronary artery stenosis – 300 of whom were randomized to PCI and the rest to CABG – showed no significant difference in major adverse cardiac or cerebrovascular events (hazard ratio, 1.27; 95% confidence interval, 0.84-1.90; P = 0.26), according to a presentation at the American College of Cardiology meeting in San Diego.
However, the study did observe a twofold increase in the rate of ischemia-driven target vessel revascularization among patients treated with PCI, compared to those who underwent CABG (HR, 2.11; 95% CI, 1.16-3.84; P = 0.012), although the authors pointed out that this did not appear to impact the study’s harder endpoints.
“Given a higher rate of repeat revascularization even after the use of second-generation drug-eluting stents for unprotected left main coronary artery stenosis, frequent repeat revascularization could be an inherent weakness of stent-related treatments,” wrote Dr. Jung-Min Ahn, from the Asan Medical Center, Seoul, and coauthors (J. Am. Coll. Cardiol. 2015; March 15 [doi:10.1016/j.jacc.2015.03.033]).
The study was supported by the CardioVascular Research Foundation, Cordis, Johnson and Johnson, and the Korean Ministry of Health & Welfare. No conflicts of interest were disclosed.