Abstract 2274: Coronary Artery Bypass Surgery Reduces a Risk of Cardiac Death in Patients with Unprotected Left Main Coronary Artery Disease : Comparactive Study with Drug-Eluting Stents
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has been replacing coronary artery bypass grafting (CABG) in the treatment for unprotected left main coronary artery (ULMCA) disease, as well as mutivessel coronary disease. We assessed the hypothesis that CABG would be superior to PCI with DES in patients with ULMCA. From January 2004 to June 2007, 160 patients underwent CABG, and 316 patients underwent PCI with DES for ULMCA disease. In CABG, 126 patients had off-pump surgery. In PCI, all patients had sirolimus-eluting stent or paclitaxel-eluting stent implantation. Survival, cardiac death, major adverse cardiac events (MACE), and target lesion revascularization (TLR) were analyzed by the Kaplan-Meier method. Preoperative characteristics and risk factors were compatible between the groups except for EuroSCORE (5.9±3.6 in CABG and 5.1±3.3 in PCI, p=0.0237) and age (68.4±9.5 in CABG and 70.5±9.7 in PCI, p=0.0253). Thirty-day mortality was 1.9% (elective cases 0%) in CABG and 1.9% (elective cases 0.7%) in PCI. Survival rate at 3 years was 88.1% in CABG and 83.4% in PCI (log-rank : p=0.1909). Cardiac death at 3 years was 97.8% in CABG and 93.1% in PCI (log-rank : p=0.0326 ). MACE-free rate at 3 years was 80.9% in CABG and 53.2% in PCI (logrank : p<0.0001). Freedom from TLR at 3 years was 93.2% in CABG and 71.4% in PCI (log-rank : p<0.0001). During the follow-up period, the PCI group had 25 late deaths among which 7 were sudden deaths. In conclusion, CABG was superior to PCI with DES in terms of mid-term outcomes including cardiac death, MACE, and TLR.