CORRESPONDENCE: LETTER TO THE EDITOR
The DELFT (Drug Eluting stent for LeFT main) Registry: The Unknowns
David Taggart, MD (Hons), PhD, FRCS*
* University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, England (Email: david.taggart{at}orh.nhs.uk).
Meliga et al. (1) are to be congratulated on their report from the DELFT (Drug Eluting stent for LeFT main) registry of "long-term" outcomes after drug-eluting stents for unprotected left main coronary artery disease.
They raise, however, 3 important issues that need further clarification.
First, rather than presenting total mortality, which is obligatory for reporting of surgical outcomes, they present the incidence of cardiac death, according to the Academic Research Consortium definition. This sets a dangerous precedent, as cardiac mortality is a less objective outcome measure than total mortality, and a better compromise would be to present both; presentation of total mortality should, however, remain mandatory.
Second, during the period of the study, 680 patients underwent coronary artery bypass grafting in the 7 participating centers. There are no data to inform whether coronary artery bypass grafting patients differed systematically from those undergoing stenting in terms of complexity of left main disease, severity of concomitant multivessel coronary artery disease, existence of comorbid conditions, or, indeed, how the decision was made as to which intervention patients would receive.
Third, there is no explicit statement as to whether all interventions were decided by a multidisciplinary team including a surgeon. The increasing tendency to report interventional treatments being based on "patient or physician preference" is both inadequate and inappropriate because it reduces the likelihood that patients will receive impartial information and, as a consequence, will not ensure that there is, therefore, real patient choice and genuine informed consent. Unless a patient is clearly unfit or unwilling to pursue a surgical option, discussion of all interventions by a multidisciplinary team should be a minimum standard of care (2–4).
 |
References
|
|---|
1. Meliga E, Garcia-Garcia HM, Valgimigli M, et al. Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease: the DELFT (Drug Eluting stent for LeFT main) registry J Am Coll Cardiol 2008;51::2212-2219.[Abstract/Free Full Text]2. Taggart DP. Coronary revascularisation BMJ 2007;334:593-594.[Free Full Text] 3. Taggart DP. Coronary artery bypass graft vs. percutaneous coronary angioplasty: CABG on the rebound? Curr Opin Cardiol 2007;22:517-523.[Medline] 4. Taggart DP, Kaul S, Boden WE, et al. Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery J Am Coll Cardiol 2008;51:885-892.[Abstract/Free Full Text]
Related Article
-
Reply
- Emanuele Meliga, Andrew O. Maree, Hector Manuel Garcia-Garcia, and Patrick W. Serruys
J. Am. Coll. Cardiol. 2008 52: 1681.
[Full Text]
[PDF]
|
Top
References