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Treatment of severe coronary artery disease with drug-eluting stents a viable alternative to CABG
February 28, 2006Severe stenosis (blockage) to the left main coronary artery-a condition commonly called a "widow-maker"- can result in sudden death. For nearly 30 years, the gold standard for treatment has been coronary artery bypass surgery (CABG).
A study conducted at Cedars-Sinai Medical Center, however, suggests that angioplasty with coronary stenting may be a viable alternative treatment to more complicated bypass surgery for patients with left main coronary artery (LMCA) disease when medication-releasing stents are used. Introduced two years ago, these types of stents slowly release medication that helps to prevent reclosure of the coronary artery.
The study reports on the short- and intermediate-term clinical outcomes of 123 patients who underwent bypass surgery and 50 who were treated medically with angioplasty and medication-releasing stents, also called drug-eluding stents. None of the patients had prior bypass surgery.
"Despite the greater percentage of high risk patients in the group who underwent coronary stenting, there was no increase in the immediate or medium-term complications compared with the group treated with bypass surgery," said Raj Makkar, M.D., director of the Interventional Cardiology and Cardiac Catheterization Laboratory at Cedars-Sinai, and principal investigator on the study. According to Makkar, this is one of the first studies in the United States on the use of medicated stents for the treatment of LMCA disease. LMCA disease is found in five to seven percent of patients who undergo angiography.
The American College of Cardiology and the American Heart Association have discouraged the medical treatment of left main coronary artery disease based on poor clinical outcomes. The authors suggest that a re-evaluation of the optimal treatment for LMCA disease be considered based the results of this study and on recent data showing that angioplasty with drug-eluding stents provides better outcomes than bare-metal stenting for LMCA disease.
Compared to the bypass surgery group, the group treated with drug-eluding stents had more patients with chronic renal insufficiency and more patients with unstable angina as the presenting symptom. Forty-six percent of the bypass surgery group was considered high-risk patients compared to 64 percent in the group treated with drug-eluting stents.
Patients treated with bypass surgery had longer hospitalizations and, after one-month, had a higher percentage of strokes, but there was no statistically significant difference in mortality or myocardial infarction. Six months after treatment, there had been seven deaths in the bypass surgery group and two in the group treated medically.
"The most important finding in this study is that, in a pilot experience with unprotected (no prior CABG surgery) LMCA disease, treatment with drug-eluting stents resulted in outcomes at least equivalent to bypass surgery ," said P. K. Shah, M.D., director of the Division of Cardiology at Cedars-Sinai. "At present, however, it is not known whether the improved outcomes in the drug-eluting stent group will be extended to all patients with LMCA disease. The results suggest a randomized comparison between the two revascularization strategies may be warranted."
Dr. Makkar agrees. "This study, while encouraging, suggests the need for larger randomized trials," he said. "We are currently in the process of doing such a study."
Cedars-Sinai Medical Center
"Despite the greater percentage of high risk patients in the group who underwent coronary stenting, there was no increase in the immediate or medium-term complications compared with the group treated with bypass surgery," said Raj Makkar, M.D., director of the Interventional Cardiology and Cardiac Catheterization Laboratory at Cedars-Sinai, and principal investigator on the study. According to Makkar, this is one of the first studies in the United States on the use of medicated stents for the treatment of LMCA disease. LMCA disease is found in five to seven percent of patients who undergo angiography.
The American College of Cardiology and the American Heart Association have discouraged the medical treatment of left main coronary artery disease based on poor clinical outcomes. The authors suggest that a re-evaluation of the optimal treatment for LMCA disease be considered based the results of this study and on recent data showing that angioplasty with drug-eluding stents provides better outcomes than bare-metal stenting for LMCA disease.
Compared to the bypass surgery group, the group treated with drug-eluding stents had more patients with chronic renal insufficiency and more patients with unstable angina as the presenting symptom. Forty-six percent of the bypass surgery group was considered high-risk patients compared to 64 percent in the group treated with drug-eluting stents.
Patients treated with bypass surgery had longer hospitalizations and, after one-month, had a higher percentage of strokes, but there was no statistically significant difference in mortality or myocardial infarction. Six months after treatment, there had been seven deaths in the bypass surgery group and two in the group treated medically.
"The most important finding in this study is that, in a pilot experience with unprotected (no prior CABG surgery) LMCA disease, treatment with drug-eluting stents resulted in outcomes at least equivalent to bypass surgery ," said P. K. Shah, M.D., director of the Division of Cardiology at Cedars-Sinai. "At present, however, it is not known whether the improved outcomes in the drug-eluting stent group will be extended to all patients with LMCA disease. The results suggest a randomized comparison between the two revascularization strategies may be warranted."
Dr. Makkar agrees. "This study, while encouraging, suggests the need for larger randomized trials," he said. "We are currently in the process of doing such a study."
Cedars-Sinai Medical Center
Coronary Artery Disease Current Events and Coronary Artery Disease News RSSMultiple health concerns surface as winter, vitamin D deficiences arrive
A string of recent discoveries about the multiple health benefits of vitamin D has renewed interest in this multi-purpose nutrient, increased awareness of the huge numbers of people who are deficient in it, spurred research and even led to an appreciation of it as "nature's antibiotic."
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
New study links vitamin D deficiency to cardiovascular disease and death
While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Learning the risks for stroke - and taking action
With this theme in mind, the European Society of Cardiology (ESC) emphasises that most of the risks for stroke are also the major risks for coronary heart disease - and thus the object of the ESC's far-reaching prevention programme.
Obesity may hinder optimal control of blood pressure and cholesterol
Obese patients taking medications to lower their blood pressure and cholesterol levels are less likely to reach recommended targets for these cardiovascular disease risk factors than their normal weight counterparts, according to new research presented at the 2009 Canadian Cardiovascular Congress hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.
South Asian Canadians failing to get exercise message
Exercise is a wonderful way of boosting heart health, but it's proving to be a tough sell in Ontario South Asian communities, Dr. Milan Gupta told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
Calcium scans may be effective screening tool for heart disease
A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death.
New type of sirolimus-eluting stent demonstrates superior results
A new type of sirolimus-eluting stent (SES) successfully showed significantly greater neointimal suppression than the paclitaxel-eluting stent (PES) with greater vessel wall integrity surrounding the stent, confirming the finding of superiority of the SES over the PES stent for the trial's primary endpoint of in-stent late loss.
Comprehensive cardiac CT scan may give clearer picture of significant heart disease
A team of researchers led by Massachusetts General Hospital (MGH) radiologists has developed a computed-tomography-based protocol that identifies both narrowing of coronary arteries and areas of myocardial ischemia - restricted blood flow to heart muscle tissue - giving a better indication of clinically significant coronary artery disease.
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