Stents versus coronary-artery bypass grafting for left main coronary artery disease.
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.
Seung
Ki Bae
KB
Catholic University of Korea, St. Mary's Hospital, Gangnam, Korea.
Park
Duk-Woo
DW
Kim
Young-Hak
YH
Lee
Seung-Whan
SW
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Park
Seong-Wook
SW
Yun
Sung-Cheol
SC
Gwon
Hyeon-Cheol
HC
Jeong
Myung-Ho
MH
Jang
Yangsoo
Y
Kim
Hyo-Soo
HS
Kim
Pum Joon
PJ
Seong
In-Whan
IW
Park
Hun Sik
HS
Ahn
Taehoon
T
Chae
In-Ho
IH
Tahk
Seung-Jea
SJ
Chung
Wook-Sung
WS
Park
Seung-Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome