Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).
The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Hiroki
H
Shiomi
Takeshi
T
Morimoto
Mamoru
M
Hayano
Yutaka
Y
Furukawa
Yoshihisa
Y
Nakagawa
Junichi
J
Tazaki
Masao
M
Imai
Kyohei
K
Yamaji
Tomohisa
T
Tada
Masahiro
M
Natsuaki
Sayaka
S
Saijo
Shunsuke
S
Funakoshi
Kazuya
K
Nagao
Koji
K
Hanazawa
Natsuhiko
N
Ehara
Kazushige
K
Kadota
Masashi
M
Iwabuchi
Satoshi
S
Shizuta
Mitsuru
M
Abe
Ryuzo
R
Sakata
Hitoshi
H
Okabayashi
Michiya
M
Hanyu
Fumio
F
Yamazaki
Mitsuomi
M
Shimamoto
Noboru
N
Nishiwaki
Yutaka
Y
Imoto
Tatsuhiko
T
Komiya
Minoru
M
Horie
Hisayoshi
H
Fujiwara
Kazuaki
K
Mitsudo
Masakiyo
M
Nobuyoshi
Toru
T
Kita
Takeshi
T
Kimura
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors