The Milan Experience Publishes 5-Year PCI Data

June 25, 2010—In the Journal of the American College of Cardiology: Cardiovascular Interventions, Alaide Chieffo, MD, et al reported the Milan Experience study's 5-year outcomes of percutaneous coronary interventions (PCI) with drug-eluting stent (DES) implantation versus coronary artery bypass grafting for unprotected left main coronary artery lesions (2010:3:595–601).

The Milan investigators sought to evaluate at 5 years the occurrence of cardiac death; cardiac death and/or myocardial infarction (MI); cardiac death, MI, and/or stroke; target vessel revascularization; and major adverse cardiac and cerebrovascular events following PCI with DES versus CABG in unprotected LMCA lesions. The background of the study is that preliminary results at 1 year showed comparable occurrence of major adverse cardiac and cerebrovascular events at the center between PCI and CABG.

As detailed by the investigators, all consecutive patients with an unprotected LMCA stenosis electively treated with DES implantation versus CABG in the center, between March 2002 and July 2004, were analyzed. A propensity analysis was performed to adjust for baseline differences between the 2 cohorts.

The study included 249 patients: 107 were treated with PCI and DES implantation and 142 with CABG. At 5-year clinical follow-up, no difference was found between PCI and CABG in the occurrence of cardiac death (adjusted odds ratio [OR], 0.502; 95% confidence interval [CI], 0.162–1.461; P = .24). The PCI group showed a trend toward a lower occurrence of the composite endpoint of cardiac death and MI (adjusted OR, 0.408; 95% CI, 0.146–1.061; P = .06). PCI was associated with a lower rate of the composite endpoint of death, MI, and/or stroke (OR, 0.399; 95% CI, 0.151–0.989; P = .04). Indeed, CABG was correlated with lower target vessel revascularization (adjusted OR, 4.411; 95% CI, 1.825–11.371; P = .0004). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular events (adjusted OR, 1.578; 95% CI, 0.825–3.054; P = 0.18).

At 5-year clinical follow-up, there was still no difference in the occurrence of major adverse cardiac and cerebrovascular events between elective PCI with DES implantation and CABG in unprotected LMCA lesions in this single-center experience. There was an advantage of PCI in the composite endpoint of death, MI, and/or stroke, whereas a benefit in the need for reintervention was still found in CABG, the investigators concluded.