Abstract 18982: Percutaneous Coronary Intervention (PCI) is Equivalent to Coronary Artery Bypass Grafting (CABG) for Unprotected Left Main Coronary Artery Disease: 5 year Follow-up Analysis
Background: The 2009 ACC/AHA updated guidelines modified the recommendation for percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) from Class III to Class IIb based on short and intermediate-term follow-up data. Long term follow up data is still lacking. We analyzed long term outcomes of revascularization by PCI and CABG in our ULMCA patients.
Methods: 343 patients undergoing ULMCA revascularization from April 2003 – January 2007 were studied. An 18 variable propensity score model (c-statistic 0.8) was used to adjust for differences in baseline characteristics. The effect of operative risk on survival was assessed using Parsonnet scores.
Results: We studied 120 PCI patients (median follow up 4.5 years) and 223 CABG patients (median follow up 5.3 years) with ULMCA disease. PCI patients were of greater surgical risk (Parsonnet score 17.2 ± 11.2 vs. 13.0 ± 9.3; p < 0.05) than CABG group. Prior to adjustment for differences in baseline characteristics, PCI was associated with higher rates of mortality (36% vs. 20%, p < 0.05) as well as death/myocardial infarction (MI)/stroke (38% vs. 25%, p < 0.05) in comparison to CABG. However, in 134 propensity matched individuals, survival (68% vs. 76%, p = 0.78, Fig. 1a) as well as freedom from death/MI/stroke (67% vs. 72%, p = 0.52, Fig. 1b) was similar between PCI and CABG, although; PCI was associated with higher rates of target vessel revascularization (19.2% vs. 5%, p = 0.02). Survival was similar in low surgical-risk candidates (Parsonnet score ≤ 15, 85% vs. 87%, p = 0.52), whereas PCI was associated with worse survival in high surgical-risk candidates (Parsonnet score >15, 46% vs. 69%, p < 0.05).
Conclusions: Long term survival is similar between PCI and CABG for ULMCA disease after adjustment for baseline clinical characteristics, suggesting that non-inferiority of PCI to CABG for ULMCA disease persists in the long term.
- © 2010 by American Heart Association, Inc.