Left Main Coronary Artery Disease (LMCAD): Stents vs CABG – The less-invasive option is Equally Safe and Effective
Reporter: Aviva Lev-Ari, PhD, RN
Original Article in NEJM
Stents, Bypass Surgery Equally Safe and Effective for Many with Left Main Heart Disease – Stents offer less-invasive option for many patients with left main coronary artery disease
Findings from the EXCEL (Evaluation of Xience versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial were published this morning online in the New England Journal of Medicine and presented at the annual Transcatheter Cardiovascular Therapeutics conference in Washington, D.C. The trial research team included interventional cardiologists and cardiac surgeons from 126 centers in 17 countries.
Coronary artery bypass graft (CABG) surgery has long been considered the definitive treatment for patients with left main coronary artery disease (LMCAD), in which the artery that supplies oxygen-rich blood to most of the heart muscle is clogged with atherosclerotic plaque. About two-thirds of all LMCAD patients have mild to moderate disease in the remainder of the coronary arteries.
“Our study has shown that many patients with left main coronary artery disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as bypass surgery for at least three years, and is initially safer, with fewer complications from the procedure,” said first author Gregg W. Stone, M.D., professor of medicine at Columbia University Medical Center and director of cardiovascular research and education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian/Columbia.
Stents, which are placed into the diseased artery via a catheter that is inserted through a small opening in a blood vessel in the groin, arm or neck, are a less-invasive treatment option for many people with coronary artery disease. However, CABG has long been considered the definitive treatment for patients with LMCAD, which affects a large portion of the heart muscle.
- Patients treated with percutaneous coronary intervention (PCI) rather than CABG had fewer MIs, and less bleeding, infections, arrhythmias and renal failure within 30 days, although more repeat revascularization procedures at three years. Fewer patients developed definite stent thrombosis after PCI than symptomatic graft occlusion after PCI at 30 days and three years.
- “Our study establishes stents as an acceptable or preferred alternative for patients with LMCAD and low or moderate disease complexity in the other three coronary arteries — about two-thirds of all LMCAD patients,” said Stone. “While bypass is still considered a more durable repair, patients and doctors may prefer a percutaneous treatment approach, which is associated with better upfront results, fewer complications, and quicker recovery.”
The researchers reported that bypass surgery should still be considered standard therapy for those with LMCAD and extensive blockages in the remainder of the heart arteries, although the study did not include patients with severe disease.