Abstract 2979: Long-Term Clinical Outcome of Percutaneous Coronary Intervention With Bare Metal Stent for Unprotected Left Main Coronary Artery Disease Compared With Bypass Graft Surgery : From the CREDO-Kyoto
Background: The long-term safety and efficacy of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease compared with coronary artery bypass grafting (CABG) in the real clinical practice has not been well clarified.
Methods: CREDO-Kyoto is a multi-center registry of Japanese patients (pts) undergoing first PCI or CABG between Jan. 2000 and Dec. 2002. Data of 9,877 consecutive pts from 30 institutions were available. Excluding those ≥ 80 years, 763 pts with LMCA disease were identified (PCI:82, CABG:681).
Results: The baseline characteristics were as follows; Age≥ 75: 33 vs 21* (%); Male: 82 vs 74 (%); Previous MI: 18 vs 25 (%); CHF: 12 vs 24* (%); Hypertension: 90 vs 81* (%); Diabetes: 37 vs 45 (%); Creatinine > 1.2 (mg/dl): 17 vs 15 (%); Hyperlipidemia: 50 vs 56 (%); Smoker: 38 vs 38 (%); EF≤ 50%: 17 vs 24 (%); Isolated LMCA disease:22 vs 10* (%), (PCI vs CABG, *p<0.05). No drug-eluting but bare metal stent was used in PCI group. Twenty (24%) underwent atherectomy of LMCA before stenting. Off pump surgery was performed in 389 pts (57%), and internal thoracic artery was used in 632 pts (93%) of CABG group. None in PCI group but 25 (3.7%) in CABG group died during the hospitalization. During the follow-up period of 3.5±1.5 years, there were 90 deaths, including 62 cardiovascular (CV) deaths. The 4-year overall and CV survival was 83.6% and 89.7% in PCI group, corresponding to 88.9% and 92.6% in CABG group (p=NS). None in PCI group and 9 (1.3%) in CABG group died suddenly. The 4-year event free survival from CV death, MI, or cerebrovascular accident (MACE) was 82.0% and 84.2%, respectively (p=NS). The cumulative risk of any revascularization at 4-year was 50.8% and 14.9%, respectively (p<0.0001). In the multivariate analyses, age and renal dysfunction were the only independent predictors of long-term overall and CV mortality. Mode of revascularization neither affected long-term mortality nor MACE rate.
Conclusions: PCI with bare metal stent is an alternative to CABG as an initial strategy for pts with unprotected LMCA disease in terms of similar long-term overall and MACE rate, though associated with a greater need for repeat revascularization.