Abstract 1846: Coronary Artery Bypass Surgery is superior to Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease
(Introduction) Improvements in results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with unprotected left main coronary artery (ULMCA) disease.
(Hypothesis) We assessed the hypothesis that coronary artery bypass grafting (CABG) would be superior to PCI with DES in patients with ULMCA.
(Methods) From January 2004 to March 2006, 114 patients underwent CABG (emergency: 42 cases), and 136 patients underwent PCI with DES (emergency: 9 cases) for ULMCA disease. In CABG, 91 patients had off-pump surgery. In PCI, all patients had sirolimus-eluting stent implantation. The mean follow-up was 621±291 days in CABG and 455±216 days in PCI. Survival, major adverse cardiac events (MACE), and target lesion revascularization (TLR) were analyzed by the Kaplan-Meier method.
(Results) Preoperative characteristics and risk factors were compatible between the groups except for EuroSCORE (8.0±3.5 in CABG and 5.0±3.0 in PCI, p<0.0001). Thirty-day mortality was 3.5% (elective cases 0%) in CABG and 0% in PCI. Survival rate at 2 years was 94.2% in CABG and 90.2% in PCI (p=0.25). Survival rate at 2 years excluding emergent cases was 98.2% in CABG and 91.2% in PCI (p<0.05)(Figure⇓). MACE-free rate at 2 years was 93.5% in CABG and 59.7% in PCI (p<0.0001). Freedom from TLR was 98.0% in CABG and 58.8% in PCI (p<0.0001). During the follow-up period, there were 2 late deaths in CABG and 11 late deaths (including 5 sudden deaths) in PCI.
(Conclusions) CABG was superior to PCI with DES in terms of long-term outcomes including survival, MACE-free, and TLR. DES carried higher risk for sudden death which might be associated with stent thrombosis.