Author + information
- Received October 20, 2010
- Revision received December 13, 2010
- Accepted January 11, 2011
- Published online May 24, 2011.
- Duk-Woo Park, MD⁎,
- Young-Hak Kim, MD⁎,
- Sung-Cheol Yun, PhD†,
- Hae Geun Song, MD⁎,
- Jung-Min Ahn, MD⁎,
- Jun-Hyok Oh, MD⁎,
- Won-Jang Kim, MD⁎,
- Jong-Young Lee, MD⁎,
- Soo-Jin Kang, MD⁎,
- Seung-Whan Lee, MD⁎,
- Cheol Whan 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 The aim of this study was to compare treatment effects of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease according to the complexity of atherosclerotic disease burden.
Background Limited information is available on the relationships between the extent of coronary atherosclerosis and very long-term outcomes of surgical or percutaneous LMCA revascularization.
Methods A total of 1,146 patients with unprotected LMCA disease who received DES (n = 645) or underwent CABG (n = 501) were evaluated. The extent of atherosclerotic disease burden was measured using the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score; a low-risk score was defined as ≤22, an intermediate-risk score as 23 to 32, and a high-risk score as ≥33.
Results After multivariate adjustment with the inverse-probability-of-treatment weighting method, the 5-year risks for death (6.1% for DES vs. 16.2% for CABG; hazard ratio [HR]: 0.52; 95% confidence interval [CI]: 0.21 to 1.28; p = 0.15) and the composite of death, Q-wave myocardial infarction, or stroke (6.4% vs. 16.2%; HR: 0.54; 95% CI: 0.22 to 1.34; p = 0.18) favored DES in patients with low-risk SYNTAX scores; in contrast, the 5-year risks for death (26.9% vs. 17.8%; HR: 1.46; 95% CI: 0.92 to 2.30; p = 0.11) and the composite outcome (27.6% vs. 19.5%; HR: 1.36; 95% CI: 0.87 to 2.12; p = 0.18) favored CABG in patients with high-risk SYNTAX scores (interaction p = 0.047 for death, interaction p = 0.08 for composite outcome). Patients undergoing CABG consistently had lower rates of target vessel revascularization.
Conclusions According to the complexity of concomitant coronary disease, there were differential treatment effects on long-term mortality in patients with unprotected LMCA disease who received DES or underwent CABG.
This study was partly supported by the Cardiovascular Research Foundation (Seoul, Korea) and by grant 0412-CR02-0704-0001 from the Korea Health 21 R&D Project, Ministry of Health and Welfare (Seoul, Korea). All authors have reported that they have no relationships to disclose.
- Received October 20, 2010.
- Revision received December 13, 2010.
- Accepted January 11, 2011.
- American College of Cardiology Foundation