Comparison of drug-eluting stent versus bypass surgery for patients with unprotected left main coronary artery disease and SYNTAX score <33: Impact of second-generation drug-eluting stent

Abstract

Purpose: Limited data are available on the clinical outcomes of second-generation DES (2nd DES) in patients with unprotected left main coronary artery (LMCA) lesions. We aimed to compare the clinical impact of 2nd DES with those of first-generation DES (1st DES) and coronary artery bypass graft (CABG) in patients with unprotected LMCA lesions and SYNTAX score <33. Methods: We identified 325 consecutive patients with unprotected LMCA lesions and SYNTAX score <33 between January 2003 and February 2012 and investigated 12-month clinical outcomes including all-cause death, cardiac death, target vessel revascularization (TVR), and major adverse cardiac and cerebrovascular events (MACCE) defined as all-cause death, myocardial infarction, TVR, and stroke. Previous PCI or CABG, hybrid LMCA stenting, and acute myocardial infarction were excluded. Results: Of the 325 patients, 112 underwent implantation of a 1st DES (Cypher, 111 patients; Taxus, 1 patient), 61 a 2nd DES (Endeavor, 26 patients; Xience, 13 patients; Nobori, 22 patients), and 152 CABG. There were no significant differences in baseline characteristics such as age, sex, hypertension, diabetes mellitus, dyslipidemia, peripheral artery disease, prior cerebrovascular event, renal failure, acute coronary syndrome, and SYNTAX score. The STS score of 1st DES was significantly lower than that of CABG (3.0 vs. 5.6, p<0.001) and was comparable to that of 2nd DES (3.0 vs. 4.3, p=0.17). The figure shows the clinical event rates. ![Figure][1] Clinical events over 12 months Conclusions: In patients with unprotected LMCA lesions and SYNTAX score <33, the clinical events rate of 2nd DES tended to be lower than those of 1st DES and were not significantly different from those of CABG. [1]: pending:yes