Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?

This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates. A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms of death, heart attacks, and stroke for the low- and intermediate-complexity groups. However, patients undergoing stenting required slightly more repeat stenting or bypass surgery afterwards. Final takeaway Ultimately, what are patients with LMCA disease to do? Based on the data, patients who have anatomically complex LMCA disease should undergo bypass surgery, if possible. In patients with low or intermediate anatomic complexity, shared decision-making between patients, cardiologists, and heart surgeons is required to determine the best treatment option for each individual patient. Some patients may be too frail or may have medical conditions that prevent them from undergoing bypass surgery. Other patients may not want the longer recovery process associated with bypass surgery, and those patients could be considered for stenting. Otherwise, bypass surgery w...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Health Heart Health Surgery Source Type: blogs