Drug-eluting stents are “noninferior” to MIDCAB for isolated LAD coronary artery disease

In a 130 patient study comparing the use of drug-eluting stents versus minimally invasive direct coronary artery bypass (MIDCAB) for the treatment of LAD coronary artery disease performed by researchers at the University of Leipzig, Germany, DES was deemed to be "noninferior" to MIDCAB.
 
While the study authors caution against applying the findings too broadly, the findings of the study are remarkable in their simplest terms for confirming that DES are competitive with coronary artery bypass in a less invasive approach than open surgery. The current state of clinical practice in coronary artery disease treatment is such that DES have achieved a level of efficacy that is competitive with CABG, particularly when considering the invasiveness (e.g., sternotomy) of CABG. However, a lingering question has been whether DES would be as competitive with CABG performed less invasively, such as in MIDCAB. This study does not conclude that DES are more effective than MIDCAB, but the findings of "not inferior" indicate that there may really be only one remaining variable to compare between the two CAD treatments, and that is cost.
 
It may be a bit simplistic to conclude that capital equipment-intensive technologies (like MIDCAB) are heavy handed and expensive, but the science and art of percutaneous coronary intervention are able to achieve outcomes at cost levels that challenge alternative technologies to be no more invasive and no more costly. It seems more reasonable to conclude that the former may be in closer reach than the latter.


Drug-eluting stents are assessed within the May 2009 report, "Worldwide Coronary Artery Stents, 2008-2017."  See link for more details.

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