Long-Term Safety and Efficacy of Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease. 5-Year Results From the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry

Duk Woo Park, Ki Bae Seung, Young Hak Kim, Jong Young Lee, Won Jang Kim, Soo Jin Kang, Seung Whan Lee, Cheol Whan Lee, Seong Wook Park, Sung Cheol Yun, Hyeon Cheol Gwon, Myung Ho Jeong, Yang Soo Jang, Hyo Soo Kim, Pum Joon Kim, In Whan Seong, Hun Sik Park, Taehoon Ahn, In Ho Chae, Seung Jea TahkWook Sung Chung, Seung Jung Park

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222 Citations (Scopus)

Abstract

Objectives: We performed the long-term follow-up of a large cohort of patients in a multicenter study receiving left main coronary artery (LMCA) revascularization. Background: Limited information is available on long-term outcomes for patients with unprotected LMCA disease who underwent coronary stent procedure or coronary artery bypass grafting (CABG). Methods: We evaluated 2,240 patients with unprotected LMCA disease who received coronary stents (n = 1,102; 318 with bare-metal stents and 784 with drug-eluting stents) or underwent CABG (n = 1,138) between 2000 and 2006 and for whom complete follow-up data were available for at least 3 to 9 years (median 5.2 years). The 5-year adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction [MI], or stroke; and target vessel revascularization [TVR]) were compared with the use of the inverse probability of treatment weighted method and propensity-score matching. Results: After adjustment for differences in baseline risk factors with the inverse probability of treatment weighting, the 5-year risk of death (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 0.88 to 1.44, p = 0.35) and the combined risk of death, Q-wave MI, or stroke (HR: 1.07; 95% CI: 0.84 to 1.37, p = 0.59) were not significantly different for patients undergoing stenting versus CABG. The risk of TVR was significantly higher in the stenting group than in the CABG group (HR: 5.11; 95% CI: 3.52 to 7.42, p < 0.001). Similar results were obtained in comparisons of bare-metal stent with concurrent CABG and of drug-eluting stent with concurrent CABG. In further analysis with propensity-score matching, overall findings were consistent. Conclusions: During 5-year follow-up, stenting showed similar rates of mortality and of the composite of death, Q-wave MI, or stroke but higher rates of TVR as compared with CABG for patients with unprotected LMCA disease.

Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalJournal of the American College of Cardiology
Volume56
Issue number2
DOIs
Publication statusPublished - 2010 Jul 6

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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