Retroinfusion-supported stenting resulted in lower 1-year event-free survival compared to bypass surgery (52.3% vs. 71.4%; P=0.02), primarily due to a higher target lesion revascularization rate.
RCT (n=44)
No
Does retroinfusion-supported stenting improve event-free survival and reduce total treatment costs compared to bypass surgery in high-risk patients with symptomatic main-stem and main-stem-equivalent lesions?
In high-risk patients with main-stem lesions, retroinfusion-supported stenting resulted in lower 1-year event-free survival compared to bypass surgery due to higher revascularization rates, but was associated with substantially lower treatment costs.
Absolute Event Rate: 52.3% vs 71.4%
p-value: p=0.02
The objective of this study was to assess event-free survival and total treatment costs of retroinfusion-supported stenting in high-risk patients compared to bypass surgery. An increasing number of patients with main-stem and main-stem-equivalent stenosis are treated by stent implantation, which appears to be safe in the short-term follow-up. However, there is a lack of randomized studies comparing conventional bypass surgery with stent implantation, particularly in patients with high risk for both treatments. We here report on the 1-year results of a prospective randomized single-center study in patients with symptomatic main-stem and main-stem-equivalent lesions with substantially increased risk for bypass surgery. Patients where randomized to undergo either percutaneous transluminal coronary angioplasty/stent procedure (n = 23) or bypass surgery (n = 21). Patients randomized to stent implantation were supported by selective pressure-regulated retroinfusion of the anterior cardiac vein during ischemia. Patients of the stent group and the bypass group did not differ in baseline characteristics, including Parsonnet score and quality-of-life score. Twenty-eight-day mortality and 1-year mortality rate as well as quality-of-life scores were similar in both groups. Event-free survival after 1 year was higher in the bypass group (71.4% vs. 52.3%; P = 0.02) due to a lower target lesion revascularization rate. With regard to total treatment costs, however, the stent group compared favorably to the bypass group (9,346 +/- 807 vs. 26,874 +/- 3,985 euro), predominantly as a result of a shorter intensive care and hospital stay. In this first randomized study in high-risk patients for stent implantation and bypass surgery, patients with retroinfusion-supported stent implantation had a similar 1-year outcome and quality of life compared to patients with bypass surgery. Though in the stent group event-free survival was lower and target lesion revascularization rate was higher, retroinfusion-supported stent implantation was associated with substantially lower costs and might be considered as an alternative treatment option in this selected group of high-risk patients.
Pohl et al. (Wed,) conducted a rct in Symptomatic main-stem and main-stem-equivalent lesions with high risk for bypass surgery (n=44). Retroinfusion-supported stenting vs. Bypass surgery was evaluated on Event-free survival after 1 year (p=0.02). Retroinfusion-supported stenting resulted in lower 1-year event-free survival compared to bypass surgery (52.3% vs. 71.4%; P=0.02), primarily due to a higher target lesion revascularization rate.