title: Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease - 5-Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort-2 - .
abstract: BACKGROUND
  Studies evaluating long-term (≥5 years) outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD) are still limited, despite concerns for late adverse events after drug-eluting stents implantation.
  
  
  RESULTS
  We identified 1,004 patients with ULMCAD (PCI: n=364, CABG: n=640) among 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. The primary outcome measure in the current analysis was a composite of death, myocardial infarction, and stroke (death/MI/stroke). The cumulative 5-year incidence of and the adjusted risk for death/MI/stroke were significantly higher in the PCI group than in the CABG group (34.5% vs. 24.1%, log-rank P<0.001, adjusted hazard ratio (HR): 1.48 [95% confidence interval (CI): 1.07-2.05, P=0.02]). The adjusted risks for all-cause death was not significantly different between the 2 groups. Regarding the stratified analysis by the SYNTAX score, the adjusted risk for death/MI/stroke was not significantly different between the 2 groups in patients with low (<23) or intermediate (23-33) SYNTAX score, whereas it was significantly higher in the PCI group than in the CABG group in patients with high (≤33) SYNTAX score.
  
  
  CONCLUSIONS
  CABG as compared with PCI was associated with better long-term outcome in patients with ULMCAD, especially those with high anatomical complexity.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.forename: Michiya
authors.initials: M
authors.lastname: Hanyu
authors.forename: Mitsuomi
authors.initials: M
authors.lastname: Shimamoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiwaki
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D002423:Cause of Death; D003131:Combined Modality Therapy; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors