Abstract 4598: Major Predictors of Long-Term Clinical Outcomes After Coronary Revascularization in Patients With Unprotected Left Main Coronary Disease: Analysis From the MAIN-COMPARE Study
Background The use of clinical characteristics to identify high-risk subsets in patients with unprotected left main coronary artery (LMCA) disease undergoing stenting or CABG is not well established.
Methods and Results We evaluated 1102 consecutive patients who underwent stenting and 1138 consecutive patients who underwent CABG for unprotected LMCA disease between January 2000 and June 2006. Twenty-five preprocedural parameters were evaluated using univariate and multivariate Cox regression analysis to identify predictors of all-cause death and TVR. Interaction test was performed to compare the risk of variables depends on the revascularization modalities. During follow-up (median 3.1 years), 187 patients died (78 PCI, 109 CABG) and 149 patients had TVR (121 PCI, 28 CABG). The independent predictors of all-cause death are shown in Table 1⇓. The interaction of left main distal bifurcation disease with treatments remained after adjustment for all independent predictors of death (Interaction p=0.0087, Table 1⇓). The independent predictors of TVR are shown in Table 2⇓. Acute coronary syndrome and involvement of left main distal bifurcation were identified as independent predictors of TVR after stenting. In case of CABG, previous PCI was the only independent predictor of TVR. The interaction between previous PCI and treatments remained after adjustment for all independent predictors of TVR (Interaction p=0.0345, Table 2⇓).
Conclusions Several clinical characteristics were identified as important preprocedural predictors of death and TVR after stenting or CABG for unprotected LMCA disease. These factors might be helpful to guide optimal strategy and risk-stratification.