title: Long-term outcomes of intervention for unprotected left main coronary artery stenosis: coronary stenting vs coronary artery bypass grafting.
abstract: 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.
authors.affiliation: 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.
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Cheng
authors.forename: Fan-Yen
authors.initials: FY
authors.lastname: Lee
authors.forename: Jen-Ping
authors.initials: JP
authors.lastname: Chang
authors.forename: Shu-Kai
authors.initials: SK
authors.lastname: Hsueh
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Hsieh
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fang
authors.forename: Shyh-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Mien-Cheng
authors.initials: MC
authors.lastname: Chen
authors.forename: Morgan
authors.initials: M
authors.lastname: Fu
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
mesh_terms: 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