Author + information
- Received December 17, 2009
- Revision received February 1, 2010
- Accepted March 8, 2010
- Published online October 19, 2010.
- Duk-Woo Park, MD⁎,
- Young-Hak Kim, MD⁎,
- Sung-Cheol Yun, PhD‡,
- Jong-Young Lee, MD⁎,
- Won-Jang Kim, MD⁎,
- Soo-Jin Kang, MD⁎,
- Seung-Whan Lee, MD⁎,
- Cheol-Whan Lee, MD⁎,
- Jae-Joong Kim, MD⁎,
- Suk-Jung Choo, MD†,
- Cheol-Hyun Chung, MD†,
- Jae-Won Lee, MD†,
- Seong-Wook Park, MD⁎ and
- Seung-Jung Park, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Seung-Jung Park, Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea
Objectives This study sought to evaluate the long-term safety and effectiveness of percutaneous coronary intervention (PCI), as compared with coronary artery bypass grafting (CABG), for unprotected left main coronary artery (LMCA) disease.
Background Data on the long-term (beyond 5-year) comparative results of treatment of unprotected LMCA disease with stent implantation or CABG are limited.
Methods We performed a 10-year clinical follow-up of 350 patients with unprotected LMCA disease who underwent PCI with bare-metal stents (BMS) (n = 100) or CABG (n = 250) from January 1995 to April 1999, and 5-year clinical follow-up of 395 patients with unprotected LMCA disease who underwent PCI with drug-eluting stents (DES) (n = 176) or CABG (n = 219) from January 2003 to May 2004. The primary safety end points were all-cause mortality and the composite of death, Q-wave myocardial infarction (MI), or stroke, and the primary efficacy end point was target vessel revascularization (TVR).
Results In the 10-year follow-up cohort of BMS and concurrent CABG, the adjusted risks of death (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.44 to 1.50; p = 0.50) and the composite of death, Q-wave MI, or stroke (HR: 0.92; 95% CI: 0.55 to 1.53; p = 0.74) were similar between the 2 groups. The rate of TVR was significantly higher in the group that received BMS (HR: 10.34; 95% CI: 4.61 to 23.18; p < 0.001). In the 5-year follow-up cohort of DES and concurrent CABG, there was no significant difference in the adjusted risk of death (HR: 0.83; 95% CI: 0.34 to 2.07; p = 0.70) or the risk of the composite outcome (HR: 0.91; 95% CI: 0.45 to 1.83; p = 0.79). The rates of TVR were also higher in the DES group than the CABG group (HR: 6.22; 95% CI: 2.26 to 17.14; p < 0.001).
Conclusions For the treatment of unprotected LMCA disease, PCI with stent implantation showed similar long-term mortality and rates of death, Q-wave MI, or stroke. However, stenting, even with DES, was associated with higher rates of repeat revascularization than was CABG.
This study was partly supported by the Cardiovascular Research Foundation, Seoul, Korea, and a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Korea (A090264). There was no industry involvement in the design, conduct, or analysis of the study. All authors have reported that they have no relationships to disclose.
- Received December 17, 2009.
- Revision received February 1, 2010.
- Accepted March 8, 2010.
- American College of Cardiology Foundation