title: Outcomes of patients with left main coronary artery disease undergoing medical or surgical treatment:  a propensity-matched analysis.
abstract: OBJECTIVE
  To evaluate the outcomes of patients with significant (≥ 50%) left main coronary artery disease (LMCAD) undergoing medical treatment (MT) or coronary artery bypass grafting surgery (CABG).
  
  
  METHODS
  A total of 181 patients with significant LMCAD were followed for 4 ± 2 years. MT was done when patients refused CABG or because of either thin native vessels or high clinical risk. Events were defined as all-cause death, myocardial infarction, percutaneous coronary intervention, or subsequent CABG. Logistic regression analysis was used to identify independent predictors of death. A propensity score was created to compare outcomes of patients from the two treatment groups.
  
  
  RESULTS
  CABG was performed in 78.5% of the patients. Overall, there were no significant differences in the incidences of death or other events between treatment groups. In patients with normal left ventricular (LV) function (ejection fraction, ≥ 45%), there were no significant differences in event rates with MT or CABG (death, 7.7 vs. 12.1%; myocardial infarction, 0 vs. 1.9%; percutaneous coronary intervention, 3.8 vs. 5.6%). For patients with LV dysfunction, death was more frequent with MT than with CABG (53.8 vs. 22.9%, P<0.001), whereas the incidence of other events was not statistically different. Age and LV dysfunction, but not treatment type, were independent predictors of death. When comparing propensity-matched patients from both treatment groups, there was also no difference in survival.
  
  
  CONCLUSIONS
  Patients with 50% or more LMCAD and LV dysfunction had increased survival with CABG. However, outcomes of patients with 50% or more LMCAD and normal LV function were not significantly different with either MT or CABG.
authors.affiliation: National Institute of Cardiology, Rio de Janeiro, Brazil. andlorenzo@hotmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: De Lorenzo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Tura
authors.forename: Fernando
authors.initials: F
authors.lastname: Bassan
authors.forename: Felipe
authors.initials: F
authors.lastname: Pittella
authors.forename: Antonio Sergio C
authors.initials: AS
authors.lastname: Rocha
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001938:Brazil; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left