Long-term outcomes of intervention for unprotected left main coronary artery stenosis: coronary stenting vs coronary artery bypass grafting.
BACKGROUND
Although recent studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) achieves clinical outcomes comparable to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease, long-term studies are rarely performed.


RESULTS
This study reviewed outcomes in 363 patients undergoing CABG (n=216), PCI with DES (n=94) or PCI with bare-metal stent (BMS) (n=53) for ULMCA stenosis between January 2000 and March 2007. The CABG group had more patients with diabetes (50.5%) and 3- or 4-vessel disease (77.3%) than the PCI group. Kaplan-Meier survival estimates showed higher TLR-free survival and revascularization-free survival in CABG group. Although cardiac-death-free survival did not significantly differ between the 3 groups, the DES group had the highest overall survival. Age (hazard ratio (HR): 1.060; 95% confidence interval (CI): 1.017-1.104) and diffuseness score (HR: 1.157; 95%CI: 1.019-1.313) were significant independent risk factors for cardiac death.


CONCLUSIONS
There was higher TLR in the PCI group with either DES or BMS, but cardiac death did not significantly differ between the 3 groups. Advanced age and diffuse coronary atherosclerosis may increase the risk of cardiac death following revascularization.
Cheng
Cheng-I
CI
Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, and Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan, ROC.
Lee
Fan-Yen
FY
Chang
Jen-Ping
JP
Hsueh
Shu-Kai
SK
Hsieh
Yuan-Kai
YK
Fang
Chih-Yuan
CY
Chen
Shyh-Ming
SM
Yang
Cheng-Hsu
CH
Yip
Hon-Kan
HK
Chen
Mien-Cheng
MC
Fu
Morgan
M
Wu
Chiung-Jen
CJ
D000368:Aged; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors