title: Comparison of one-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease and acute coronary syndromes (from the CUSTOMIZE Registry).
abstract: Uncertainty surrounds the optimal revascularization strategy for patients with left main coronary artery disease presenting with acute coronary syndromes (ACSs), and adequately sized specific comparisons of percutaneous and surgical revascularization in this scenario are lacking. The aim of this study was to evaluate the incidence of 1-year major adverse cardiac events (MACEs) in patients with left main coronary artery disease and ACS treated with percutaneous coronary intervention (PCI) and drug-eluting stent implantation or coronary artery bypass grafting (CABG). A total of 583 patients were included. At 1 year, MACEs were significantly higher in patients treated with PCI (n = 222) compared to those treated with CABG (n = 361, 14.4% vs 5.3%, p <0.001), driven by a higher rate of target lesion revascularization (8.1% vs 1.7%, p = 0.001). This finding was consistent after statistical adjustment for MACEs (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.2 to 5.9, p = 0.01) and target lesion revascularization (adjusted HR 8.0, 95% CI 2.2 to 28.7, p = 0.001). No statistically significant differences between PCI and CABG were noted for death (adjusted HR 1.1, 95% CI 0.4 to 3.0, p = 0.81) and myocardial infarction (adjusted HR 4.8, 95% CI 0.3 to 68.6, p = 0.25). No interaction between clinical presentation (ST-segment elevation myocardial infarction or unstable angina/non-ST-segment elevation myocardial infarction) and treatment (PCI or CABG) was observed (p for interaction = 0.68). In conclusion, in patients with left main coronary artery disease and ACS, PCI is associated with similar safety compared to CABG but higher risk of MACEs driven by increased risk of repeat revascularization.
authors.affiliation: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Caggegi
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.forename: Alberto
authors.initials: A
authors.lastname: Chisari
authors.forename: Margherita
authors.initials: M
authors.lastname: Ministeri
authors.forename: Andrea
authors.initials: A
authors.lastname: Mangiameli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronsivalle
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ricca
authors.forename: Giombattista
authors.initials: G
authors.lastname: Barrano
authors.forename: Sergio
authors.initials: S
authors.lastname: Monaco
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Di Salvo
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries