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Coronary Stenting Remains the First Revascularization Option in Most Patients with a Clinical Indication for Myocardial Revascularization

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Controversies in Cardiology

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Abstract

In the past, randomized clinical trials (RCT) either with the use of plain old balloon angioplasty or bare metal stents (BMS) did not show a survival advantage with coronary artery graft surgery (CABG) in spite of a greater number of repeat revascularization procedures (TVR) with angioplasty. Moreover, meta-analysis from RCT in the BMS era showed similar survival and the incidence of myocardial infarction (MI) between PCI and CABG including diabetic patients.

With the introduction of drug eluting stents (DES) in the past decade, the incidence of TVR and restenosis was significantly reduced, although the high incidence of stent thrombosis in the very late period after DES implantation introduced a cause of concern.

Recently, long term follow up of new RCTs between PCI with 1st generation DES versus CABG showed poor survival and a high incidence of MI when they were treated with 1st generation DES in comparison with CABG. However, patients treated with surgery had a threefold increase in stroke.

Simultaneously with these studies, a large improvement in the design of DES platforms was observed which significantly enhanced the safety profile of these devices. Several well conducted RCT and also large registries demonstrated the safety profile of these new DES platforms, including biocompatible or biodegradable polymers or complete bioabsorbable stents. All showed a remarkably low rate of adverse events with these new DES designs, either in comparison to 1st generation DES or BMS. Furthermore, the incidence of very late stent thrombosis was almost zero.

In summary, the current safety gap between PCI and CABG in complex lesion subsets, three vessel CAD and diabetics, should not be closed until new RCT with the last generation of DES have been conducted.

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Author information

Authors and Affiliations

  1. Department of Interventional Cardiology, Otamendi Hospital and Sanatorio Las Lomas, Buenos Aires, Argentina

    Juan Mieres MD

  2. Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina

    Nicolás Herscovich MD

  3. Cardiac Unit, Department of Interventional Cardiology, Revista Argentina de Cardioagiologia Intervencionista (RACI), Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  4. Interventional Cardiology Unit, Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  5. Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  6. Cardiovascular Research Center (CECI), Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

Authors
  1. Juan Mieres MD
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  2. Nicolás Herscovich MD
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  3. Alfredo E. Rodríguez MD, PhD, FACC, FSCAI
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Corresponding author

Correspondence to Alfredo E. Rodríguez MD, PhD, FACC, FSCAI .

Editor information

Editors and Affiliations

  1. UCSF Fresno, Fresno, California, USA

    John A. Ambrose

  2. Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez

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Mieres, J., Herscovich, N., Rodríguez, A.E. (2015). Coronary Stenting Remains the First Revascularization Option in Most Patients with a Clinical Indication for Myocardial Revascularization. In: Ambrose, J., Rodríguez, A. (eds) Controversies in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-20415-4_14

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  • DOI: https://doi.org/10.1007/978-3-319-20415-4_14

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20414-7

  • Online ISBN: 978-3-319-20415-4

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