Stents versus coronary-artery bypass grafting for left main coronary artery disease
Ki Bae Seung1, Duk-Woo Park, Young-Hak Kim
1Catholic University of Korea, St. Mary's Hospital, Gangnam, Korea.
Insights
For unprotected left main coronary artery disease, coronary stenting and coronary-artery bypass grafting (CABG) showed similar long-term survival and composite outcomes. However, stenting led to significantly higher rates of target-vessel revascularization compared to CABG.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Unprotected left main coronary artery disease poses significant risks.
- Coronary stenting and coronary-artery bypass grafting (CABG) are common interventions.
- Long-term outcome data comparing these treatments for unprotected left main disease are limited.
Purpose of the Study:
- To compare the long-term effectiveness of coronary stenting versus CABG.
- To evaluate adverse outcomes including death, myocardial infarction, stroke, and revascularization.
- To analyze outcomes based on stent type (bare-metal vs. drug-eluting).
Main Methods:
- A cohort study of 1102 patients receiving stents and 1138 patients undergoing CABG.
- Patients had unprotected left main coronary artery disease.
- Propensity-score matching was used to compare outcomes in the overall cohort and subgroups.
Main Results:
- No significant difference in death rates between stenting and CABG (HR 1.18, 95% CI 0.77-1.80).
- No significant difference in the composite outcome of death, Q-wave MI, or stroke (HR 1.10, 95% CI 0.75-1.62).
- Significantly higher target-vessel revascularization rates in the stenting group (HR 4.76, 95% CI 2.80-8.11).
Conclusions:
- Coronary stenting and CABG offer comparable long-term survival and composite event rates for unprotected left main disease.
- Stenting, including with drug-eluting stents, is associated with increased need for target-vessel revascularization.
- Treatment choice should consider the higher revascularization risk with stenting.
Background:
Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease.
Methods:
We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent.
Results:
In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [CI], 0.77 to 1.80) or the risk of the composite outcome (hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents.
Conclusions:
In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG.
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