title: Unprotected left main coronary artery disease in patients with low predictive risk of mortality.
abstract: BACKGROUND
  There has been an increasing use of percutaneous coronary intervention with drug-eluting stent (DES) in patients with unprotected left main coronary artery disease. We assessed whether coronary artery bypass grafting (CABG) would be superior to percutaneous coronary intervention with first-generation DES in patients with unprotected left main coronary artery disease.
  
  
  METHODS
  Between January 2003 and December 2007, a total of 295 patients with unprotected left main coronary artery disease were treated with Kurashiki Central Hospital, Okayama, Japan. Among these patients, 169 and 126 underwent CABG and percutaneous coronary intervention with DES, respectively. The average Society of Thoracic Surgeons' predictive risk of mortality score was 2.3±3.8%. We defined higher-risk and lower-risk patients as those with Society of Thoracic Surgeons' predictive risk of mortality scores higher than 2.3% (CABG, n=48; percutaneous coronary intervention, n=28) and lower than 2.3% (CABG, n=121; percutaneous coronary intervention, n=98), respectively. Survival, major adverse cardiac-related events, and target lesion revascularization were analyzed by the Kaplan-Meier method.
  
  
  RESULTS
  Between-group differences in favor of CABG were seen with respect to the rate of major adverse cardiac-related events and target lesion revascularization in both strata. In patients with lower scores according to the Society of Thoracic Surgeons' predictive risk of mortality, the cardiac death-free survival rate was significantly higher in CABG.
  
  
  CONCLUSIONS
  In this 5-year single-center experience, CABG is recommended for unprotected left main coronary artery disease, especially in patients with low scores in the Society of Thoracic Surgeons' predictive risk of mortality.
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Watanabe
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Genichi
authors.initials: G
authors.lastname: Sakaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamoto
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome