Mid-term results and costs of coronary artery bypass vs drug-eluting stents for unprotected left main coronary artery disease.
BACKGROUND
The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).


RESULTS
Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2+/-1.1 years in the CABG group and 1.6+/-0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen).


CONCLUSIONS
CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease.
Shimizu
Tsuyoshi
T
Department of Cardiothoracic Surgery, The University of Tokyo, Japan. tshimizu-cvs@umin.ac.jp
Ohno
Takayuki
T
Ando
Jiro
J
Fujita
Hideo
H
Nagai
Ryozo
R
Motomura
Noboru
N
Ono
Minoru
M
Kyo
Shunei
S
Takamoto
Shinichi
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000601:surgery; D054855:Drug-Eluting Stents / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality