In a 10-year observational study, researchers found no differences in major adverse cardiac and cerebrovascular events (MACCE) incidence between left main stenting and surgical revascularization in patients with unprotected left main coronary artery stenosis.
LE MANS (Left Main Stenting) trial investigators randomly assigned 105 patients with unprotected left main coronary artery stenosis with low and medium complexity of coexisting coronary artery disease (CAD) to undergo either percutaneous coronary intervention (PCI) with stenting (n=52) or coronary artery bypass grafting (CABG; n=53). Thirty-five percent of patients were implanted with drug-eluting stents (DES) and 81% were treated with arterial grafts to the left anterior descending artery.
Higher ejection fraction in stenting compared with surgery was reported at 10 years (54.9% ± 8.3% vs 49.8% ± 10.3%; P=.07). Mortality and MACCE rates were not statistically different between groups, but numerically, stenting showed an advantage. The same was true for myocardial infarction (8.7% vs 10.4%; P=.62), stroke (4.3% vs 6.3%; P=.68), and repeated revascularization (26.1% vs 31.3%; P=.64) rates. Long-term survival was also comparable between PCI and CABG, but there was a trend toward a higher MACE-free survival in the PCI group (34.7% vs 22.1%; P=.06).
Left ventricular ejection fraction (LVEF) as assessed by 2-dimensional echocardiography at 1 year served as the primary end point. MACCE and cerebral events were secondary end points at the 10-year follow-up.
This was the first prospective trial that randomly evaluated left main stenting and CABG for this patient population. Improved LVEF in the stenting group at long-term follow-up was consistent with the 1-year follow-up, but given the lower number of eligible patients, the researchers acknowledged the statistical significance was not reached.
Furthermore, both strategies did offer positive long-term outcomes, with survival rates at nearly 70% and 80% in the surgical and percutaneous groups, respectively. Incidence of myocardial infarction and repeated revascularization rates did not differ between groups.
Researchers called for “a definitive, statistically-powered trial showing noninferiority of PCI and CABG in patients with left main disease and low and medium complexity of coexisting [CAD] with results extending to 5-year follow-up.”
Buszman PE, Buszman PP, Banasiewicz-Szkróbka I, et al. Left main stenting in comparison with surgical revascularization. 10-year outcomes of the (Left Main Coronary Artery Stenting) LE MANS trial. JACC Cardiovasc Interv. 2016;9(4):318-327. doi: 10.1016/j.jcin.2015.10.044.