Heart and Vascular Health
32.5K views | +3 today
Follow
Heart and Vascular Health
Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
Your new post is loading...
Your new post is loading...
Scooped by Seth Bilazarian, MD
Scoop.it!

Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis

Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis | Heart and Vascular Health | Scoop.it

Although clinical practice guidelines carry a higher class of recommendation for CABG surgery (Class IIa) than for catheter-based deployment of drug eluting stents (DES) (Class IIb), when revascularization is indicated for patients with ischemia due to significant stenosis in CAD isolated to the PLAD, a comprehensive registry in the state of New York found no differences between these approaches in either mortality rates or the combined rates of mortality, MI, and/or stroke, although CABG was associated with lower rates of repeated revascularization.

Seth Bilazarian, MD's insight:

For many years we have had good evidence that there is not a significant difference in death or other major hazard between bypass surgery or angioplasty with stents.  This information from the New York State registry adds important information because of its size and the use of drug eluting stents.  The one significant difference is that the angioplasty group needed more repeat procedures over 3 years; Repeat procedures were needed in 1 in 17 of the bypass patients and 1 in 9 of the stent patients.  This information is welcome addition to help our patients make an informed decision about whiich option is best for them.

more...
No comment yet.
Scooped by Seth Bilazarian, MD
Scoop.it!

10 years ago the first drug eluting stent data published: Sirolimus-Eluting Cypher Stent in Sirius Trial

10 years ago the first drug eluting stent data published: Sirolimus-Eluting Cypher Stent in Sirius Trial | Heart and Vascular Health | Scoop.it

Randomized, double-blind trial comparing a sirolimus-eluting stent with a standard stent in 1058 patients at 53 centers in the United States who had a newly diagnosed lesion in a native coronary artery. The coronary disease in these patients was complex because of the frequent presence of diabetes (in 26 percent of patients), the high percentage of patients with longer lesions (mean, 14.4 mm), and small vessels (mean, 2.80 mm). The primary end point was failure of the target vessel (a composite of death from cardiac causes, myocardial infarction, and repeated percutaneous or surgical revascularization of the target vessel) within 270 days.

Results The rate of failure of the target vessel was reduced from 21.0 percent with a standard stent to 8.6 percent with a sirolimus-eluting stent (P<0.001) — a reduction that was driven largely by a decrease in the frequency of the need for revascularization of the target lesion (16.6 percent in the standard-stent group vs. 4.1 percent in the sirolimus-stent group, P<0.001). The frequency of neointimal hyperplasia within the stent was also decreased in the group that received sirolimus-eluting stents, as assessed by both angiography and intravascular ultrasonography. Subgroup analyses revealed a reduction in the rates of angiographic restenosis and target-lesion revascularization in all subgroups examined.

Conclusions

In this randomized clinical trial involving patients with complex coronary lesions, the use of a sirolimus-eluting stent had a consistent treatment effect, reducing the rates of restenosis and associated clinical events in all subgroups analyzed.

Seth Bilazarian, MD's insight:

10 years ago the coronary interventional world was revolutionized with the publication and availability of the first drug eluting stent (DES) for coronary artery disease treated with angioplasty. We have several newer versions since and this first version is no longer available and the company that manufactured it ($JNJ) has exited the business.
This innovation has made the minimally invasive treatment of coronary artery disease more durable since the chance of re-narrowing at the site of the stent is less than 10%..

more...