Abstract 4597: Five Year Outcomes Following Drug-eluting Stents Implantation vs. Coronary Artery Bypass Graft Surgery for Unprotected Left Main Coronary Artery Lesions: Milan Experience
Background: One-year outcome following drug-eluting stent (DES) implantation versus coronary artery by-pass grafting (CABG) in unprotected left main coronary artery (LMCA) lesions have been previously reported from our center.
Methods: All consecutive patients with an unprotected LMCA stenosis electively treated with DES implantation versus CABG in our Center, between March 2002 and July 2004, were analysed. Hierarchical study end points were occurrence at 5 years of: cardiac death; cardiac death and/or myocardial infarction (MI); cardiac death, MI and/or stroke; target vessel revascularization (TVR, defined as any revascularization in left coronary system); and major cardiac cerebrovascular events (MACCE). A propensity analysis was performed to adjust for baseline differences between the two cohorts.
Results: Two-hundred forty-nine patients were included in the study: 107 were treated with PCI and DES implantation and 142 with CABG. At 5 year-clinical follow-up, no difference was found between PCI and CABG in the occurrence of cardiac death (adjusted OR=0.502; 95% CI=0.162 to 1.461; P=0.24). PCI group showed a trend toward a lower occurrence of the composite endpoint of cardiac death and myocardial infarction (adjusted OR=0.408; 95% CI=0.146 1.061; P=0.06). PCI was associated with a lower rate of the composite endpoint of death, MI and/or stroke (OR=0.399; 95% CI=0.151 to 0.989; P=0.04). Indeed, CABG was correlated to lower TVR (adjusted OR=4.411; 95% CI=1.825–11.371; p=0.0004). No difference was detected in the occurrence of MACCE (adjusted OR=1.578; 95% CI=0.825 to 3.054; P=0.18).
Conclusions: At 5 year-clinical follow-up, in this single-center experience, there was still no difference in the occurrence of MACCE between elective PCI with DES implantation and CABG in LMCA lesions. There was an advantage of PCI in the composite endpoint of death, MI and/or stroke, while a benefit in the need for re-intervention was still found in CABG.