Follow-up Finds Comparable Outcomes With BMS and Minimally Invasive Surgery

A 10-year follow-up analysis of the results of a randomized trial comparing the use of bare-metal stenting with minimally invasive bypass surgery for isolated proximal left-anterior descending coronary artery stenosis in 220 patients was published on Jan. 21 in JACC Cardiovascular Interventions, and found similar long-term outcomes.

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The analysis found no significant difference in the incidence of the primary composite endpoint of freedom from major cardiac adverse events, defined as death from any cause, myocardial infarction (MI) and the need for repeated target vessel revascularization, among patients who received bare-metal stenting vs. those who were treated with surgery (47 percent vs. 36 percent, respectively; p = 0.12) and no significant difference in so-called hard endpoints of death and MI. However, in the secondary endpoint of target vessel revascularization, the revascularization rate was higher with stenting (34 percent vs. 11 percent with surgery; p * 0.01).

The difference in the secondary endpoint was largely due to a significantly higher target vessel revascularization rate found in the stenting group in the first analysis period of zero to seven months after treatment (p * 0.01). In the subsequent follow-up period of seven months to 10 years, the difference was no longer significant (p = 0.53).

The study confirms the results of previous six-month and five-year follow-up studies of the randomized trial. In the initial trial, a cardiac surgeon and a cardiologist randomized 220 patients with isolated high-grade lesions of the proximal left-anterior descending coronary artery to receive either bare-metal stents or minimally invasive direct coronary artery bypass surgery. Follow-up results were collected by structured patient interviews at five years and 10 years.

The authors noted that previous studies have shown that restenosis rates of up to 50 percent have been associated with bare-metal stenting for proximal left-anterior descending coronary artery stenoses and that these restenosis rates have been dramatically reduced since the introduction of drug-eluting stents.

Keywords: Myocardial Infarction, Coronary Stenosis, Drug-Eluting Stents, Coronary Vessels, Coronary Artery Bypass, Stents, Minimally Invasive Surgical Procedures

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