Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.
OBJECTIVE
The purpose of this study was to compare the early and late results of percutaneous and surgical revascularization of left main coronary artery stenosis.


BACKGROUND
Unprotected left main coronary artery (ULMCA) stenting is being investigated as an alternative to bypass surgery.


METHODS
We randomly assigned 105 patients with ULMCA stenosis to percutaneous coronary intervention (PCI; 52 patients) or coronary artery bypass grafting (CABG; 53 patients). The primary end point was the change in left ventricular ejection fraction (LVEF) 12 months after the intervention. Secondary end points included 30-day major adverse events (MAE), major adverse cardiac and cerebrovascular events (MACCE), length of hospitalization, target vessel failure (TVF), angina severity and exercise tolerance after 1 year, and total and MACCE-free survival.


RESULTS
A significant increase in LVEF at the 12-month follow-up was noted only in the PCI group (3.3 +/- 6.7% after PCI vs. 0.5 +/- 0.8% after CABG; p = 0.047). Patients performed equally well on stress tests, and angina status improved similarly in the 2 groups. PCI was associated with a lower 30-day risk of MAE (p < 0.006) and MACCE (p = 0.03) and shorter hospitalizations (p = 0.0007). Total and MACCE-free 1-year survival was comparable. Left main TVF was similar in the 2 groups. During the 28.0 +/- 9.9-month follow-up, there were 3 deaths in the PCI group and 7 deaths in the CABG group (p = 0.08).


CONCLUSIONS
Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.
Buszman
Pawel E
PE
Medical University of Silesia, Katowice, Poland. pbuszman@ka.onet.pl
Kiesz
Stefan R
SR
Bochenek
Andrzej
A
Peszek-Przybyla
Ewa
E
Szkrobka
Iwona
I
Debinski
Marcin
M
Bialkowska
Bozena
B
Dudek
Dariusz
D
Gruszka
Agata
A
Zurakowski
Aleksander
A
Milewski
Krzysztof
K
Wilczynski
Miroslaw
M
Rzeszutko
Lukasz
L
Buszman
Piotr
P
Szymszal
Jan
J
Martin
Jack L
JL
Tendera
Michal
M
D000787:Angina Pectoris / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000453:epidemiology; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome