Author + information
- Received July 16, 2009
- Revision received November 25, 2009
- Accepted November 30, 2009
- Published online June 8, 2010.
- Young-Hak Kim, MD, PhD*,
- Duk-Woo Park, MD, PhD*,
- Won-Jang Kim, MD*,
- Jong-Young Lee, MD*,
- Sung-Cheol Yun, PhD†,
- Soo-Jin Kang, MD, PhD*,
- Seung-Whan Lee, MD, PhD*,
- Cheol Whan Lee, MD, PhD*,
- Myeong-Ki Hong, MD, PhD*,
- Seong-Wook Park, MD, PhD* and
- Seung-Jung Park, MD, PhD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Seung-Jung Park, Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
Objectives This study was designed to examine the impact of the extent of coronary disease on long-term outcomes after coronary stenting or coronary artery bypass graft (CABG) surgery for unprotected left main coronary artery (ULMCA) stenosis.
Background The differential outcome of ULMCA revascularization according to the coronary involvement remains uncertain.
Methods From the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization) registry, 2,240 patients with ULMCA stenosis who underwent either stenting or CABG were stratified by number of diseased vessels.
Results Following adjustment with EuroSCORE (European System for Cardiac Operative Risk Evaluation), diabetes mellitus, and bifurcation stenosis, stents and CABG had similar risks of death and major adverse cardiac events including death, Q-wave myocardial infarction, or stroke in all subgroups regardless of the number of diseased vessels over 4 years. In patients with 2-vessel (23.0% vs. 14.2%; hazard ratio [HR]: 1.739; 95% confidence interval [CI]: 1.171 to 2.582; p = 0.006) or 3-vessel (25.0% vs. 17.6%; HR: 1.493; 95% CI: 1.096 to 2.035; p = 0.011) disease, however, stenting was associated with a higher risk of major adverse cardiac and cerebrovascular events including major adverse cardiac events or target vessel revascularization than CABG. Interaction of vascular involvement with type of stent or CABG was not significant.
Conclusions Stenting appears to be a safe alternative to CABG in patients having ULMCA stenosis combined with additional vascular disease. The advantage of CABG over stenting lies principally in the reduction of repeat revascularization across subgroups stratified by the number of diseased vessels.
Supported by a grant of the Korea Health 21 Research and Development Project, Ministry of Health and Welfare, Republic of Korea (A090264).
- Received July 16, 2009.
- Revision received November 25, 2009.
- Accepted November 30, 2009.
- American College of Cardiology Foundation