Abstract 15681: Comparison of Five-year Outcomes of Percutaneous Coronary Intervention With Drug-eluting Stent Versus Bypass Surgery for Patients With Unprotected Left Main Coronary Artery Disease: Impact of Renal Insufficiency
Objective: We sought to evaluate the impact of renal insufficiency on the five-year outcomes of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) or coronary artery bypass grafting (CABG) for patients with unprotected left main coronary artery (LMCA) disease.
Methods: We identified patients with unprotected LMCA disease who had undergone DES implantation or CABG between January 2003 and December 2007, and investigated long-term clinical outcomes. Moreover, we defined the patients with eGFR<30ml/min/1.73m² or on hemodialysis as patients with severe renal insufficiency (SRI) and stratified all patients into four groups, according to this definition. Patients who had prior PCI or CABG, those who underwent concomitant valvular or aortic surgery, and those who had acute myocardial infarction were excluded.
Results: A total of 295 patients with unprotected LMCA disease met the inclusion criteria. Of these, 126 patients were treated with PCI with DES and 169 with CABG. The median duration of follow-up was 1732 days (interquartile range, 1331 to 2130 days). CABG patients had significantly higher-risk clinical profiles than PCI patients: cerebrovascular disease (PCI vs. CABG: 11.1% vs. 21.9%, p=0.015); emergent procedure (10.3% vs. 24.9%, p=0.002); EuroSCORE (4.4 vs. 5.5, p=0.008), and 82.5% (104/126) of PCI patients underwent sirolimus-eluting stent implantation and 69.2% (117/169) of CABG patients underwent off-pump CABG. There was no significant difference in the five-year rate of all-cause death between PCI and CABG (19.8% vs. 15.4%, p=0.18). The figure shows the rate of all-cause death in the four groups.
Conclusions: At five-year follow-up, in this single-center experience, PCI was associated with the higher mortality among patients with unprotected LMCA disease and end-stage renal disease.
- © 2011 by American Heart Association, Inc.