PCI with everolimus-eluting stents reported more MACE, finds a study: NEJM

More major adverse cardiac events (MACE) were reported in patients who have undergone percutaneous coronary intervention (PCI) with everolimus-eluting stents than among those who had undergone CABG as per a recent study that was published in the journal The New England Journal of Medicine. 

PCI is a non-surgical, invasive procedure done to relieve the occluded blood vessels. Trials done in the past comparing PCI with coronary-artery bypass grafting (CABG) have not made use of second-generation drug-eluting stents. Hence researchers conducted a study to compare the rate of MACE among those who had undergone PCI with the use of everolimus-eluting stents with those who had undergone CABG. 

A randomized noninferiority trial at 27 centers in East Asia was done by randomly assigning 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary endpoint was a composite of death, myocardial infarction, or target-vessel revascularization 2 years after randomization. Event rates during longer-term follow-up were also compared between groups. 

Results:

• Among the 880 patients who participated in the study, 438 patients were randomly assigned to the PCI group and 442 to the CABG group.
• At 2 years, the primary endpoint had occurred in 11.0% of the patients in the PCI group and 7.9% of those in the CABG group.
• At longer-term follow-up, the endpoint point had occurred in 15.3% of the patients in the PCI ground in 10.6% of those in the CABG group.
• No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke.
• However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG. 

Thus, the researchers concluded that the rate of major adverse cardiovascular events was more among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. 

For full reading: 10.1056/NEJMoa1415447

Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-1212.