TCT-410 Comparison of Coronary Artery Bypass Surgery, Percutaneous Drug-eluting Stent Implantation, and Medical Therapy for Unprotected Left Main Coronary Artery Disease

Abstract

Background: Unprotected left main coronary artery (ULMCA) disease is considered an indication for revascularization. However, in “real-world” clinical practice some patients receive medical therapy only. The arm of this study was to evaluate long-term results in patients with ULMCA disease in a “real-world” practice. Methods: Between January 2006 and June 2011, 218 stable patients were diagnosed with de novo ULMCA stenosis. 52 (23.9%) patients received medical therapy only, coronary artery bypass grafting (CABG) was performed in 106 (48.6%) patients, percutaneous coronary intervention (PCI) in 60 (27.5%) patients. The composite of death, myocardial infarction, and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) were defined as primary endpoints. The median follow-up period was 4 years. Results: Baseline clinical and descriptive morphology of coronary artery disease revealed more comorbidities and more complex anatomies in the medical therapy group compare with CABG and PCI groups. Revascularization might not have been used due to physician's decision (operative risk considered excessive) in 24 (46.2%) cases or when patients refused revascularization in 28 (53.8%) cases. At 4-year follow-up MACCE rate was higher in nonsurgical group (34.6%) compare with CABG (13.2%; p1⁄40.002) and PCI (14.5%; p1⁄40.016) groups, but there was no difference between CABG and PCI groups. Survival in CABG (4.7%; p<0.001) and PCI (5.5%; p1⁄40.009) groups was higher in compare with nonsurgical group (23.1%). On the multivariable Cox regression analysis, coronary revascularization (CABG and PCI) was independent predictor of long-term survival (HR 3.49; 95% CI 1.39-8.75; P<0.001). Conclusions: PCI, like CABG improves survival for patients with unprotected left main coronary artery disease compared with medical therapy only in “real-world” clinical practice.