Comparison of Short- and Long-Term Clinical Outcomes of Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in 121 Patients with Unprotected Left Main Coronary Artery Disease

Abstract

Although previous studies have shown promising safety and feasibility outcomes for percutaneous coronary in- tervention (PCI) with drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease, limited data are available for comparison of DES implantation versus coronary artery bypass grafting (CABG) for ULMCA stenosis. A total of 121 symptomatic patients with >50% angiographic stenosis in the ULMCA underwent PCI with DES (PCI group, n=60) or CABG (CABG group, n=61). Cumulative incidence of major adverse cardiac events (MACE) including death, myocardial infarction and target-vessel revascularization were evaluated at follow-up. Baseline clinical characteristics were comparable in both groups except for a lower incidence of triple-vessel coronary disease in the PCI group compared to the CABG group (32% vs. 80%, p < 0.01). Stent implantation was successful in all lesions of the PCI group. The mean follow-up period was 20±12 months in the CABG group and 17±10 months in the PCI group. The incidence of MACE in the CABG group was significantly higher than that in the PCI group (9.8% vs. 0%, p < 0.01). And the total combined rate of MACE, heart dysfunction, cerebral infarction and re-hospitalization was also higher in the CABG group compared to the PCI group (32% vs. 0%, p < 0.01). This study indicates that PCI of ULMCA lesions with DES is safe and effective, and might be superior to CABG in some selective patients. In the PCI group, no serious proce- dure-related complication was observed, and the short- and long-term prognosis was better than that in the CABG group.