title: Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease.
abstract: BACKGROUND
  There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.
  
  
  METHODS
  All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.
  
  
  RESULTS
  Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.
  
  
  CONCLUSIONS
  During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.
authors.forename: Xian-Peng
authors.initials: XP
authors.lastname: Yu
authors.forename: Chang-Yan
authors.initials: CY
authors.lastname: Wu
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Ren
authors.forename: Fei
authors.initials: F
authors.lastname: Yuan
authors.forename: Xian-Tao
authors.initials: XT
authors.lastname: Song
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Luo
authors.forename: Ji-Qiang
authors.initials: JQ
authors.lastname: He
authors.forename: Yue-Chun
authors.initials: YC
authors.lastname: Gao
authors.forename: Fang-Jiong
authors.initials: FJ
authors.lastname: Huang
authors.forename: Cheng-Xiong
authors.initials: CX
authors.lastname: Gu
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Sun
authors.forename: Shu-Zheng
authors.initials: SZ
authors.lastname: Lyu
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D013318:Stroke Volume