Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.
BACKGROUND
Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis.


RESULTS
Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266).


CONCLUSIONS
At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.
Chieffo
Alaide
A
Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
Morici
Nuccia
N
Maisano
Francesco
F
Bonizzoni
Erminio
E
Cosgrave
John
J
Montorfano
Matteo
M
Airoldi
Flavio
F
Carlino
Mauro
M
Michev
Iassen
I
Melzi
Gloria
G
Sangiorgi
Giuseppe
G
Alfieri
Ottavio
O
Colombo
Antonio
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002561:Cerebrovascular Disorders; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate
D004364:Pharmaceutical Preparations