Author + information
- Received February 9, 2015
- Revision received March 5, 2015
- Accepted March 6, 2015
- Published online May 26, 2015.
- Jung-Min Ahn, MD∗,
- Jae-Hyung Roh, MD∗,
- Young-Hak Kim, MD∗,
- Duk-Woo Park, MD∗,
- Sung-Cheol Yun, PhD†,
- Pil Hyung Lee, MD∗,
- Mineok Chang, MD∗,
- Hyun Woo Park, MD∗,
- Seung-Whan Lee, MD∗,
- Cheol Whan Lee, MD∗,
- Seong-Wook Park, MD∗,
- Suk Jung Choo, MD∗,
- CheolHyun Chung, MD∗,
- JaeWon Lee, MD∗,
- Do-Sun Lim, MD‡,
- Seung-Woon Rha, MD§,
- Sang-Gon Lee, MD‖,
- Hyeon-Cheol Gwon, MD¶,
- Hyo-Soo Kim, MD#,
- In-Ho Chae, MD∗∗,
- Yangsoo Jang, MD††,
- Myung-Ho Jeong, MD‡‡,
- Seung-Jea Tahk, MD§§,
- Ki Bae Seung, MD‖‖ and
- Seung-Jung Park, MD∗∗ ()
- ∗Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- †Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- ‡Korea University Anam Hospital, Seoul, South Korea
- §Korea University Kuro Hospital, Seoul, South Korea
- ‖Ulsan University Hospital, Ulsan, South Korea
- ¶Samsung Medical Center, Seoul, South Korea
- #Seoul National University Hospital, Seoul, South Korea
- ∗∗Seoul National University Hospital, Bundang, South Korea
- ††Yonsei University Severance Hospital, Seoul, South Korea
- ‡‡Chonnam National University Hospital, Gwangju, South Korea
- §§Ajou University Medical Center, Suwon, South Korea
- ‖‖Catholic University of Korea, St. Mary’s Hospital, Seoul, South Korea
- ↵∗Reprint requests and correspondence:
Dr. Seung-Jung Park, Heart Institute, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
Background In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year.
Objectives This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.
Methods We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.
Results At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).
Conclusions During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)
This study was supported by funds from the CardioVascular Research Foundation, Seoul, South Korea; Cordis, a Johnson & Johnson Company, Miami Lakes, Florida; and Health 21 R&D Project, Ministry of Health & Welfare, Seoul, South Korea (HI10C2020). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ahn and Roh contributed equally to this paper.
- Received February 9, 2015.
- Revision received March 5, 2015.
- Accepted March 6, 2015.
- American College of Cardiology Foundation