Temporal trends in revascularization strategy and outcomes in left main coronary artery stenosis: data from the ASAN Medical Center-Left MAIN Revascularization registry.
BACKGROUND
Changes over time in revascularization strategies and outcomes among patients with unprotected left main coronary artery stenosis remain largely unknown.


RESULTS
A total of 2618 consecutive patients with unprotected left main coronary artery stenosis who underwent revascularization were identified from the ASAN Medical Center-Left MAIN Revascularization registry and classified by time periods: bare metal stent (wave 1, 1995-1998), early drug-eluting stents (wave 2, 2003-2006), and late drug-eluting stents (wave 3, 2007-2010). Primary end point was major adverse cerebrocardiovascular events (the composite of death, myocardial infarction, repeat revascularization, and stroke). During the study period, 1124 patients underwent percutaneous coronary intervention (PCI) and 1494 patients underwent coronary artery bypass grafting. The proportion of PCI significantly increased from 35% to 52% between waves 1 and 3. In patients receiving PCI, the risk-adjusted incidence rate of major adverse cerebro-cardiovascular events decreased from 20.18 cases per 100 person-years in wave 1 to 6.77 cases per 100 person-years in wave 3 (P<0.001 for trend). Death, the composite of death, myocardial infarction, stroke, and repeat revascularization were also significantly decreased by 40%, 35%, and 46%, respectively. The risk-adjusted incidence rate of major adverse cerebrocardiovascular events did not change in patients receiving coronary artery bypass grafting. The difference major adverse cerebrocardiovascular events risk between PCI and coronary artery bypass grafting progressively reduced (adjusted hazard ratio [95% confidence interval], 0.33 [0.23-0.47]; 0.53 [0.35-0.80]; and 1.01 [0.68-1.49] from wave 1 to wave 3.


CONCLUSIONS
The outcomes of unprotected left main coronary artery PCI have significantly improved over time. In addition, more patients received PCI for unprotected left main coronary artery stenosis in recent years.
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. sjpark@amc.seoul.kr.
Seung-Jung
SJ
Park
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Jung-Min
JM
Ahn
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Young-Hak
YH
Kim
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Duk-Woo
DW
Park
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Sung-Cheol
SC
Yun
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Sung-Han
SH
Yoon
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Hyun Woo
HW
Park
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Mineok
M
Chang
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Jong-Young
JY
Lee
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Soo-Jin
SJ
Kang
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Seung-Whan
SW
Lee
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Cheol Whan
CW
Lee
From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Seong-Wook
SW
Park
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D023921:Coronary Stenosis / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies
bypass surgery, coronary artery; cerebral revascularization; coronary artery disease; stent