Author + information
- Received August 7, 2018
- Revision received September 12, 2018
- Accepted September 12, 2018
- Published online September 24, 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, MDk,
- Yangsoo Jang, MDe,
- Hyo-Soo Kim, MDf,
- In-Whan Seong, MDg,
- Hun Sik Park, MDh,
- Taehoon Ahn, MDi,
- In-Ho Chae, MDf,
- Seung-Jea Tahk, MDj and
- Seung-Jung Park, MDa,∗ ()
- aDepartments of Cardiology
- 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
- kChonnam National University Hospital, Gwangju, Korea
- eYonsei University Severance Hospital, Seoul, Korea
- fSeoul National University Hospital, and Bundang, Seoul, Korea
- gChungnam National University Hospital, Daejeon, Korea
- hKyung Pook National University Hospital, Daegu, Korea
- iGachon University Gil Medical Center, Incheon, Korea
- jAjou University Medical Center, Suwon, Korea
- ↵∗Address for correspondence: Seung-Jung Park, MD 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 Telephone: +82-2-3010-4812 Fax: +82-2-475-6898.
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.
Objective To compare 10-year outcomes after PCI and CABG for LMCA disease.
Methods In this observational study of the MAINCOMPARE registry, we evaluated 2240 patients with unprotected LMCA disease who underwent PCI (n=1102) or underwent CABG (n=1138) 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 two 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 [HR], 1.35; 95% confidence interval [CI], 1.00–1.81) and the composite outcome (HR, 1.46; 95% CI, 1.10–1.94) compared to CABG.
Conclusions In patients with significant LMCA disease, as compared with CABG, PCI showed similar rates of death and serious composite outcome, but a higher rate of target-vessel revascularization at 10 years. However, CABG showed lower mortality and serious composite outcome rates compared to PCI with drug-eluting stents after 5 years.
↵∗ The first two authors (Drs. D.W. Park and J.M. Ahn) contributed equally to this article.
Disclosures: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding: This work was partly supported by grants from the Cardiovascular Research Foundation of South Korea.
Role of the Sponsors: There was no industry involvement in the design, conduct, or analysis of the study.
- Received August 7, 2018.
- Revision received September 12, 2018.
- Accepted September 12, 2018.
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