10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease

Duk Woo Park, Jung Min Ahn, Sung Cheol Yun, Yong Hoon Yoon, Do Yoon Kang, Pil Hyung Lee, Seung Whan Lee, Seong Wook Park, Ki Bae Seung, Hyeon Cheol Gwon, Myung Ho Jeong, Yangsoo Jang, Hyo Soo Kim, In Whan Seong, Hun Sik Park, Taehoon Ahn, In Ho Chae, Seung Jea Tahk, Seung Jung Park

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23 Citations (Scopus)

Abstract

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. Objectives: The authors compare 10-year outcomes after PCI and CABG for LMCA disease. Methods: In this observational study of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization) registry, the authors evaluated 2,240 patients with unprotected LMCA disease who underwent PCI (n = 1,102) or underwent CABG (n = 1,138) 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 2 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: 1.35; 95% confidence interval: 1.00 to 1.81) and the composite outcome (hazard ratio: 1.46; 95% confidence interval: 1.10 to 1.94) compared with CABG. Conclusions: In patients with significant LMCA disease, as compared with CABG, PCI showed similar rates of death and serious composite outcomes, but a higher rate of target-vessel revascularization at 10 years. However, CABG showed lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years. (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization [MAIN-COMPARE]; NCT02791412)

Original languageEnglish
Pages (from-to)2813-2822
Number of pages10
JournalJournal of the American College of Cardiology
Volume72
Issue number23
DOIs
Publication statusPublished - 2018 Dec 11

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Park, D. W., Ahn, J. M., Yun, S. C., Yoon, Y. H., Kang, D. Y., Lee, P. H., Lee, S. W., Park, S. W., Seung, K. B., Gwon, H. C., Jeong, M. H., Jang, Y., Kim, H. S., Seong, I. W., Park, H. S., Ahn, T., Chae, I. H., Tahk, S. J., & Park, S. J. (2018). 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease. Journal of the American College of Cardiology, 72(23), 2813-2822. https://doi.org/10.1016/j.jacc.2018.09.012