Physically fit patients who need heart procedures are traditionally referred for major surgery, but the benefits of minimally invasive procedures are starting to outweigh the disadvantages in these individuals, researchers reported at the ACC meeting.
In a trial called FAME 3, 1,500 relatively healthy patients with blockages in three coronary arteries, but not in the left main artery known as the "widow maker", were recruited between 2014 and 2019.
They underwent either a percutaneous coronary intervention via a small incision through the skin, or coronary artery bypass grafting (CABG) surgery, which involves sawing through the breastbone and stopping the heart and requires weeks or months of recovery.
None of the patients was at particularly high risk for complications from open-heart surgery.
Researchers had earlier reported that one year into the study, the combined rate of death, stroke, heart attack, or need for a repeat procedure to reopen the arteries was higher in the minimally invasive group, suggesting the major surgery was still the best option for these patients.
But now, five years out, there is no significant difference in the composite of death, stroke, or heart attack between the two groups, the researchers say.
"This is the only study to compare CABG and PCI as they are currently used in cardiology – incorporating recent advances in surgical and minimally invasive techniques as well as in medical therapy – in patients with triple-vessel disease," study leader Dr. William Fearon of Stanford University School of Medicine in California said in a statement.
Looking at the endpoints individually, rates of death and stroke were similar in the two groups, but PCI patients had higher risks for heart attack (8% vs 5%) and repeat revascularization (16% vs 8%) than the CABG group.
The narrowing in the outcomes difference between the two approaches is likely due to improved stent technology, the routine use of new techniques for selecting which arteries to treat with PCI, and greater patient adherence to medical therapy, Fearon's team said in The Lancet.
In a trial involving 1,478 relatively healthy patients who needed aortic valve replacement, rates of death or disabling stroke at five years were similar whether the valve was replaced through a small incision in the arm or via standard open-heart surgery, Dr. Michael Reardon of Houston Methodist Hospital and colleagues reported at the meeting and in The Journal of the American College of Cardiology.
However, in a separate third study of 1,618 patients who were at intermediate or high risk for surgical complications – also reported at the meeting and in the Journal of the American College of Cardiology - five-year outcomes were significantly better after minimally invasive procedures than after surgery, Reardon's team said.
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