Author + information
- Received August 7, 2018
- Revision received September 12, 2018
- Accepted September 12, 2018
- Published online December 3, 2018.
- Duk-Woo Park, MDa,∗,
- Jung-Min Ahn, MDa,∗,
- Sung-Cheol Yun, PhDb,
- Yong-Hoon Yoon, MDa,
- Do-Yoon Kang, MDa,
- Pil Hyung Lee, MDa,
- Seung-Whan Lee, MDa,
- Seong-Wook Park, MDa,
- Ki Bae Seung, MDc,
- Hyeon-Cheol Gwon, MDd,
- Myung-Ho Jeong, MDe,
- Yangsoo Jang, MDf,
- Hyo-Soo Kim, MDg,
- In-Whan Seong, MDh,
- Hun Sik Park, MDi,
- Taehoon Ahn, MDj,
- In-Ho Chae, MDk,
- Seung-Jea Tahk, MDl and
- Seung-Jung Park, MDa,∗ ()
- aDepartment of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- bDivision of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- cThe Catholic University of Korea, St. Mary’s Hospital, GangNam, Seoul, Korea
- dSamsung Medical Center, Seoul, Korea
- eChonnam National University Hospital, Gwangju, Korea
- fYonsei University Severance Hospital, Seoul, Korea
- gSeoul National University Hospital, Seoul, Korea
- hChungnam National University Hospital, Daejeon, Korea
- iKyung Pook National University Hospital, Daegu, Korea
- jGachon University Gil Medical Center, Incheon, Korea
- kSeoul National University Hospital, Bundang, Korea
- lAjou University Medical Center, Suwon, Korea
- ↵∗Address for 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, Republic of Korea.
Background Comparative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease were previously reported. However, data on very long-term (>10 years) outcomes are limited.
Objectives The authors compare 10-year outcomes after PCI and CABG for LMCA disease.
Methods In this observational study of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization) registry, the authors evaluated 2,240 patients with unprotected LMCA disease who underwent PCI (n = 1,102) or underwent CABG (n = 1,138) between January 2000 and June 2006. Adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) were compared with the use of propensity scores and inverse-probability-weighting adjustment. The follow-up was extended to at least 10 years of all patients (median 12.0 years).
Results In the overall cohort, there was no significant difference in adjusted risks of death and the composite outcome between the groups up to 10 years. The risk of target-vessel revascularization was significantly higher in the PCI group. In the cohort comparing drug-eluting stents and concurrent CABG, the 2 study groups did not differ significantly in the risks of death and the composite outcome at 5 years. However, after 5 years, drug-eluting stents were associated with higher risks of death (hazard ratio: 1.35; 95% confidence interval: 1.00 to 1.81) and the composite outcome (hazard ratio: 1.46; 95% confidence interval: 1.10 to 1.94) compared with CABG.
Conclusions In patients with significant LMCA disease, as compared with CABG, PCI showed similar rates of death and serious composite outcomes, but a higher rate of target-vessel revascularization at 10 years. However, CABG showed lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years. (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization [MAIN-COMPARE]; NCT02791412)
↵∗ Drs. D.-W. Park and J.-M. Ahn contributed equally to this work.
This work was partly supported by grants from the Cardiovascular Research Foundation of South Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2018.
- Revision received September 12, 2018.
- Accepted September 12, 2018.
- 2018 American College of Cardiology Foundation
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