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Do Drug-Eluting Stents Mark The End of Coronary Artery Bypass Surgery?

Singapore

The first 300 words of the full text of this article appear below.

When drug-eluting stents became available, there was much enthusiasm since the restenosis rate employing this application appeared to be significantly better than with bare metal stents. Questions have been raised on whether there is still a place for coronary artery bypass surgery (CABG). Since the results of stents in terms of restenosis are excellent, this euphoria led Dr Patrick Serruys to state that "If I am in a dream, please don’t wake me." It is however timely to wake up the interventional cardiologists from their trance state and ask them some questions:

QUESTION 1

Can drug-eluting stents match the results from coronary artery bypass surgery (CABG), let alone do any better than CABG?

No. 30-day mortality rates for CABG is approximately 3% despite an increase in preoperative risk factors.¹ Late survival following coronary artery bypass grafting has also been excellent with the Coronary Artery Surgery Study reporting survival rates of 90% at 5 years.²

QUESTION 2

Can drug-eluting stents provide global revascularization equivalent to CABG?

No. In terms of completeness of revascularization, drug-eluting stents cannot be compared to CABG. Referring to incomplete revascularization with stents, Dr Rod Stable, principle investigator of the SOS trial states that "even before restenosis has a chance of affecting the outcome, surgery is already ahead."³

QUESTION 3

Do drug-eluting stents meet the gold standards set by the left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis?

No. Data from the Cleveland Clinic Foundation Registry demonstrate that of 484 internal mammary grafts studied more than 10 years after surgery, 95% were still patent.⁴

QUESTION 4

Can we extrapolate the results of drug-eluting stent trials to the real world practice of interventional cardiology?

No. We have to bear in mind that the major drug-eluting stent trials are basically trials on simple lesions, mostly single vessel disease with short segment stenoses, in highly . . . [Full Text of this Article]

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