10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease
Park DW, Ahn JM, Park SJ et al.

KEYWORDS
bypass surgery; coronary artery disease; left main coronary artery disease; stents

BACKGROUND - Comparative outcomes of coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease were previously reported. However, data on very long-term (>10 years) outcomes are limited.

OBJECTIVE - To compare 10-year outcomes after PCI and CABG for LMCA disease.

METHODS - In this observational study of the MAINCOMPARE registry, we evaluated 2240 patients with unprotected LMCA disease who underwent PCI (n=1102) or underwent CABG (n=1138) between January 2000 and June 2006. Adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) were compared with the use of propensity scores and inverse-probability-weighting adjustment. The follow-up was extended to at least 10 years of all patients (median, 12.0 years).

RESULTS - In the overall cohort, there was no significant difference in adjusted risks of death and the composite outcome between the groups up to 10 years. The risk of target-vessel revascularization was significantly higher in the PCI group. In the cohort comparing drug-eluting stents and concurrent CABG, the two study groups did not differ significantly in the risks of death and the composite outcome at 5 years. However, after 5 years, drug-eluting stents were associated with higher risks of death (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.00-1.81) and the composite outcome (HR, 1.46; 95% CI, 1.10-1.94) compared to CABG.

CONCLUSIONS - In patients with significant LMCA disease, as compared with CABG, PCI showed similar rates of death and serious composite outcome, but a higher rate of target-vessel revascularization at 10 years. However, CABG showed lower mortality and serious composite outcome rates compared to PCI with drug-eluting stents after 5 years.

Copyright © 2018. Published by Elsevier Inc.