title: Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study.
abstract: BACKGROUND
  In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year.
  
  
  OBJECTIVE
  This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.
  
  
  METHODS
  We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.
  
  
  RESULTS
  At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).
  
  
  CONCLUSIONS
  During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968).
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Jung-Min
authors: JM
authors: Ahn
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Jae-Hyung
authors: JH
authors: Roh
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Young-Hak
authors: YH
authors: Kim
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Duk-Woo
authors: DW
authors: Park
authors: Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Pil Hyung
authors: PH
authors: Lee
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Mineok
authors: M
authors: Chang
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Hyun Woo
authors: HW
authors: Park
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Seung-Whan
authors: SW
authors: Lee
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Cheol Whan
authors: CW
authors: Lee
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Seong-Wook
authors: SW
authors: Park
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Suk Jung
authors: SJ
authors: Choo
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: CheolHyun
authors: C
authors: Chung
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: JaeWon
authors: J
authors: Lee
authors: Korea University Anam Hospital, Seoul, South Korea.
authors: Do-Sun
authors: DS
authors: Lim
authors: Korea University Kuro Hospital, Seoul, South Korea.
authors: Seung-Woon
authors: SW
authors: Rha
authors: Ulsan University Hospital, Ulsan, South Korea.
authors: Sang-Gon
authors: SG
authors: Lee
authors: Samsung Medical Center, Seoul, South Korea.
authors: Hyeon-Cheol
authors: HC
authors: Gwon
authors: Seoul National University Hospital, Seoul, South Korea.
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Seoul National University Hospital, Bundang, South Korea.
authors: In-Ho
authors: IH
authors: Chae
authors: Yonsei University Severance Hospital, Seoul, South Korea.
authors: Yangsoo
authors: Y
authors: Jang
authors: Chonnam National University Hospital, Gwangju, South Korea.
authors: Myung-Ho
authors: MH
authors: Jeong
authors: Ajou University Medical Center, Suwon, South Korea.
authors: Seung-Jea
authors: SJ
authors: Tahk
authors: Catholic University of Korea, St. Mary's Hospital, Seoul, South Korea.
authors: Ki Bae
authors: KB
authors: Seung
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000601:surgery*; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus
keywords: coronary artery bypass grafting; long-term outcome; percutaneous coronary intervention