According to a report in the Journal of the American College of Cardiology, sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) are equally effective for treating patients with unprotected left main coronary artery disease (CAD), Reuters Health reported.
Based on our many experiences, percutaneous coronary intervention with drug-eluting stents could be a comparable option for patients who refuse or are afraid of coronary artery bypass graft surgery, Dr. Jong-Young Lee from University of Ulsan College of Medicine, Seoul, Korea, told Reuters Health in an email.
The physicians compared the clinical outcomes of 858 patients with unprotected left main coronary artery disease after implantation of SES and PES. Of these 669 patients received SES and 189 received PES.
These 858 patients were participants in a larger study comparing angioplasty with surgical revascularization.
The two groups had similar rates of in-hospital death (2.4% after SES, 2.6% after PES), Q-wave myocardial infarctions, urgent revascularizations, and procedural success, the authors report.
During the ensuing follow-up (median, 852 days), the risks of death, myocardial infarction, target vessel revascularization, and the primary composite outcome combining these three endpoints were similar in the SES and PES groups.
Although only seven patients (0.8%) had definite or probable stent thrombosis (0.6% after SES, 1.6% after PES), the researchers note, two patients died of stent thrombosis, for a case-fatality rate of 28.6%.
Our data showed that the most currently used drug-eluting stents (SES or PES) had similar clinical long-term clinical outcomes in terms of death, myocardial infarction, and repeat revascularization and showed lower or, at worst, similar rates of stent thrombosis than are observed with other coronary lesions, Dr. Lee said.
Randomized trials with long-term follow-up are required to clarify the long-term efficacy and safety of drug-eluting stent implantation compared to coronary artery bypass graft surgery for treatment of unprotected left main coronary artery disease, Dr. Lee said. Other studies with newer generation stents in which more worldwide centers participate should be performed for left main coronary disease.