Yonsei Med J.  2012 Jan;53(1):58-67. 10.3349/ymj.2012.53.1.58.

Comparison of Coronary Artery Bypass Grafting with Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease

• Kawecki D
• Morawiec B
• Fudal M
• Milejski W
• Jachec W
• Nowalany-Kozielska E

• KMID: 1779687
• DOI: http://doi.org/10.3349/ymj.2012.53.1.58

Abstract

PURPOSE
Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs).
MATERIALS AND METHODS
The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS).
RESULTS
Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49+/-4.09 vs. 4.81+/-2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016).
CONCLUSION
Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.

Keyword

Left main; PCI; DES; CABG

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/*mortality
Cohort Studies
Coronary Artery Bypass/*mortality
*Coronary Artery Disease/mortality/surgery/therapy
Coronary Vessels
*Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Male
Metals
Middle Aged
Risk Factors
Treatment Outcome

Figure

• 

  Fig. 1 Outcomes. DES, drug-eluting stent; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; BMS, bare metal stents; CI, confidence interval; EF, ejection fraction; IABP, intra-aortic balloon pump; LM+3VD, left main combined with three-vessel disease; MACCE, major adverse cardio-cerebral events; OR, odds ratio.

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