Stents versus coronary-artery bypass grafting for left main coronary artery disease

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.