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(Circulation. 2006;113:2542-2547.)
© 2006 American Heart Association, Inc.

Interventional Cardiology

Percutaneous Treatment With Drug-Eluting Stent Implantation Versus Bypass Surgery for Unprotected Left Main Stenosis

A Single-Center Experience

Alaide Chieffo, MD; Nuccia Morici, MD; Francesco Maisano, MD; Erminio Bonizzoni, PhD; John Cosgrave, MD; Matteo Montorfano, MD; Flavio Airoldi, MD; Mauro Carlino, MD; Iassen Michev, MD; Gloria Melzi, MD; Giuseppe Sangiorgi, MD; Ottavio Alfieri, MD; Antonio Colombo, MD

From Interventional Cardiology (A.C., N.M., J.C., M.M., F.A., M.C., I.M., G.M., G.S., A.C.) and Cardiac Surgery Units (F.M., O.A.), San Raffaele Scientific Institute, Milan, Italy; and Institute of Medical Statistics and Biometry (E.B.), University of Milan, Italy.

Correspondence to Antonio Colombo, MD, San Raffaele Hospital, Via Olgettina 62, 20132 Milan, Italy. E-mail colombo.antonio{at}hsr.it

Received October 15, 2005; revision received February 27, 2006; accepted March 2, 2006.

Background— Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis.

Methods and Results— Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266).

Conclusions— At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease. (Circulation. 2006;113:2542-2547.)

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