title: Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease-A single-center experience.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center.
  
  
  METHODS
  We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85% male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7-6.5 years).
  
  
  RESULTS
  All-cause death (PCI/CABG: 27.4%/31.5%; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8%/35.9%; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6%/11.0%; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results.
  
  
  CONCLUSIONS
  PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Tse-Min
authors.initials: TM
authors.lastname: Lu
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Wan-Liang
authors.initials: WL
authors.lastname: Lee
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Pai-Feng
authors.initials: PF
authors.lastname: Hsu
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ting-Chao
authors.initials: TC
authors.lastname: Lin
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Kang-Ling
authors.initials: KL
authors.lastname: Wang
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Shao-Sung
authors.initials: SS
authors.lastname: Huang
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Wan-Leong
authors.initials: WL
authors.lastname: Chan
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Shih
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: hsucp@vghtpe.gov.tw.
authors.forename: Chiao-Po
authors.initials: CP
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D015607:Stents; D020521:Stroke / Q000209:etiology
keywords: coronary artery bypass grafting; coronary stent; left main coronary artery disease; percutaneous coronary intervention