Drug-eluting stent on left main disease is usually adopted in patients with low SYNTAX score and have good clinical outcomes during 1 year. Real-world single-center experience comparing with coronary artery bypass graft

Abstract

Background: Current practice guidelines still recommend coronary artery bypass graft (CABG) as the standard treatment in patients with left main coronary disease (LMCD). The purpose of our study is to assess the realworld selection of therapeutic strategy in patients with LMCD and their outcomes using SYNTAX and euroSCORE. Methods: We analyzed data of 100 consecutive patients with significant LMCD treated by percutaneous coronary intervention with DES (n=44) or CABG (n=56). All lesions of the LMCD were de novo lesions. We calculate the SYNTAX score and the euroSCORE and assessed the clinical outcomes during 1 year. Results: Patients baseline characteristics between groups were wellbalanced including logistic euroSCORE (3.54±3.98% in the PCI group and 3.28±2.47% in the CABG group, P=.699). The PCI with DES on LMCD was adopted in patients with low SYNTAX score compared with those of the CABG group (22.0±7.6 vs. 35.9±8.6, P=.000). These differences of the two groups were derived by the number of coronary artery lesion (2.8±1.1 vs. 4.0±1.3 lesions, P=.000) and presence of chronic total occlusion artery [9.0% (4/44) vs. 46.4% (26/56), P=.000]. One-year major adverse cardiac events rates did not differ between the PCI with DES group and the CABG group [6.8% (3/44) vs. 3.5% (2/56), P=.465]. And this result of MACE continued in low–intermediate SYNTAX group [6.6% (1/15) vs. 2.0% (1/49), P=.516]. All MACEs were cardiac death during hospitalization, and further events including cardiac death, nonfatal myocardial infarction and need for revascularization procedures did not develop during the follow-up period after discharge. Mortality rates according to SYNTAX score in all LMCD patients were 2.7% (1/37) of the low-score group (≤22), 3.7% (1/27) of the intermediate-score group (23 to 32), and 8.3% (3/36) of the high-score group (≥33); however, statistical significance was not significant. Conclusions: Single-center real-world experience showed therapeutic strategy by PCI with DES in LMCD was usually adopted in patients with low SYNTAX score and had low incidence of MACE during 1 year. However, CABG still remains the dominant revascularization strategy, especially in the patients with high SYNTAX score. Prospective, long-term, randomized studies to evaluate the clinical outcomes between PCI and CABG are warranted in LMCD with high SYNTAX score.