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, Myeongki 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

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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

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Coronary Artery Bypass
Stents
Coronary Artery Disease
Drug-Eluting Stents
Confidence Intervals
Stroke
Myocardial Infarction
Propensity Score
Mortality
Korea
Metals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Ki, B. S., Park, D. W., Kim, Y. H., Lee, S. W., Cheol, W. L., Hong, M., ... 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
Ki, Bae Seung ; Park, Duk Woo ; Kim, Young Hak ; Lee, Seung Whan ; Cheol, Whan Lee ; Hong, Myeongki ; Park, Seong Wook ; Yun, Sung Cheol ; Gwon, Hyeon Cheol ; Jeong, Myung Ho ; Jang, Yangsoo ; Kim, Hyo Soo ; Pum, Joon Kim ; Seong, In Whan ; Hun, Sik Park ; Ahn, Taehoon ; Chae, In Ho ; Tahk, Seung Jea ; Chung, Wook Sung ; Park, Seung Jung. / Stents versus coronary-artery bypass grafting for left main coronary artery disease. In: New England Journal of Medicine. 2008 ; Vol. 358, No. 17. pp. 1781-1792.
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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.",
author = "Ki, {Bae Seung} and Park, {Duk Woo} and Kim, {Young Hak} and Lee, {Seung Whan} and Cheol, {Whan Lee} and Myeongki Hong and Park, {Seong Wook} and Yun, {Sung Cheol} and Gwon, {Hyeon Cheol} and Jeong, {Myung Ho} and Yangsoo Jang and Kim, {Hyo Soo} and Pum, {Joon Kim} and Seong, {In Whan} and Hun, {Sik Park} and Taehoon Ahn and Chae, {In Ho} and Tahk, {Seung Jea} and Chung, {Wook Sung} and Park, {Seung Jung}",
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Ki, BS, Park, DW, Kim, YH, Lee, SW, Cheol, WL, Hong, M, Park, SW, Yun, SC, Gwon, HC, Jeong, MH, Jang, Y, Kim, HS, Pum, JK, Seong, IW, Hun, SP, Ahn, T, Chae, IH, Tahk, SJ, Chung, WS & Park, SJ 2008, 'Stents versus coronary-artery bypass grafting for left main coronary artery disease', New England Journal of Medicine, vol. 358, no. 17, pp. 1781-1792. https://doi.org/10.1056/NEJMoa0801441

Stents versus coronary-artery bypass grafting for left main coronary artery disease. / Ki, Bae Seung; Park, Duk Woo; Kim, Young Hak; Lee, Seung Whan; Cheol, Whan Lee; Hong, Myeongki; Park, Seong Wook; Yun, Sung Cheol; Gwon, Hyeon Cheol; Jeong, Myung Ho; Jang, Yangsoo; Kim, Hyo Soo; Pum, Joon Kim; Seong, In Whan; Hun, Sik Park; Ahn, Taehoon; Chae, In Ho; Tahk, Seung Jea; Chung, Wook Sung; Park, Seung Jung.

In: New England Journal of Medicine, Vol. 358, No. 17, 24.04.2008, p. 1781-1792.

Research output: Contribution to journalArticle

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T1 - Stents versus coronary-artery bypass grafting for left main coronary artery disease

AU - Ki, Bae Seung

AU - Park, Duk Woo

AU - Kim, Young Hak

AU - Lee, Seung Whan

AU - Cheol, Whan Lee

AU - Hong, Myeongki

AU - Park, Seong Wook

AU - Yun, Sung Cheol

AU - Gwon, Hyeon Cheol

AU - Jeong, Myung Ho

AU - Jang, Yangsoo

AU - Kim, Hyo Soo

AU - Pum, Joon Kim

AU - Seong, In Whan

AU - Hun, Sik Park

AU - Ahn, Taehoon

AU - Chae, In Ho

AU - Tahk, Seung Jea

AU - Chung, Wook Sung

AU - Park, Seung Jung

PY - 2008/4/24

Y1 - 2008/4/24

N2 - 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.

AB - 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.

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