Stents versus coronary-artery bypass grafting for left main coronary artery disease

Bae Seung Ki, Duk Woo Park, Young Hak Kim, Seung Whan Lee, Whan Lee Cheol, Myeong Ki Hong, Seong Wook Park, Sung Cheol Yun, Hyeon Cheol Gwon, Myung Ho Jeong, Yangsoo Jang, Hyo Soo Kim, Joon Kim Pum, In Whan Seong, Sik Park Hun, Taehoon Ahn, In Ho Chae, Seung Jea Tahk, Wook Sung Chung, Seung Jung Park

Research output: Contribution to journalArticle

387 Citations (Scopus)

Abstract

BACKGROUND: Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease. METHODS: We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent. RESULTS: In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [CI], 0.77 to 1.80) or the risk of the composite outcome (hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents. CONCLUSIONS: In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG.

Original languageEnglish
Pages (from-to)1781-1792
Number of pages12
JournalNew England Journal of Medicine
Volume358
Issue number17
DOIs
Publication statusPublished - 2008 Apr 24

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Fingerprint Dive into the research topics of 'Stents versus coronary-artery bypass grafting for left main coronary artery disease'. Together they form a unique fingerprint.

  • Cite this

    Ki, B. S., Park, D. W., Kim, Y. H., Lee, S. W., Cheol, W. L., Hong, M. K., Park, S. W., Yun, S. C., Gwon, H. C., Jeong, M. H., Jang, Y., Kim, H. S., Pum, J. K., Seong, I. W., Hun, S. P., Ahn, T., Chae, I. H., Tahk, S. J., Chung, W. S., & Park, S. J. (2008). Stents versus coronary-artery bypass grafting for left main coronary artery disease. New England Journal of Medicine, 358(17), 1781-1792. https://doi.org/10.1056/NEJMoa0801441