Related Experiment Video
Updated: Jun 30, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Utilization and outcomes of unprotected left main coronary artery stenting and coronary artery bypass graft surgery
Chuntao Wu1, Edward L Hannan, Gary Walford
1University at Albany, State University of New York, Albany, New York, USA. chuntao.wu@psu.edu
Insights
Coronary artery bypass graft (CABG) surgery is linked to better survival and fewer repeat procedures for left main coronary artery (LMCA) disease compared to stenting. Stent patients were generally sicker, indicating CABG may be preferred for sicker individuals.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited contemporary data exists on revascularization outcomes for unprotected left main coronary artery (LMCA) disease.
- Unprotected LMCA disease poses significant risks, necessitating effective treatment strategies.
Purpose of the Study:
- To compare the frequency, severity of illness, and outcomes of stenting versus coronary artery bypass graft (CABG) surgery for unprotected LMCA disease.
- To evaluate the relative effectiveness of these revascularization methods in a large patient cohort.
Main Methods:
- Retrospective analysis of 16,548 patients undergoing revascularization for unprotected LMCA disease in New York (2000-2004).
- Propensity score matching was used to compare 135 CABG patients with 135 stent patients.
- Follow-up data was analyzed through December 31, 2004, including survival and repeat revascularization rates.
Main Results:
- Stent recipients presented with higher preprocedural illness severity.
- Matched CABG patients demonstrated significantly higher 2-year survival rates (94.1% vs. 82.0%) and freedom from repeat revascularization (93.7% vs. 62.7%) compared to stent patients.
- In the drug-eluting stent era (late 2003-2004), similar trends favored CABG for mortality, though repeat revascularization rates showed a significant benefit for drug-eluting stents.
Conclusions:
- Coronary artery bypass graft (CABG) surgery was the predominant revascularization strategy for unprotected LMCA disease, with sicker patients receiving stenting.
- CABG surgery was associated with a lower risk of long-term death and repeat revascularization.
- Further research is warranted to compare these procedures, particularly with the advent of drug-eluting stents.
Background:
Limited contemporary information is available on outcomes for patients with unprotected left main coronary artery (LMCA) disease who are revascularized.
Methods:
We examined the relative frequency, severity of illness, and outcomes of stenting and coronary artery bypass graft (CABG) surgery for treating unprotected LMCA disease in New York between January 1, 2000 and December 31, 2004. A total of 16,336 (98.7%) patients who underwent CABG surgery and 212 (1.3%) who underwent stenting were included in this study.
Results:
Stent patients had higher preprocedural severity of illness (eg, they were older, more likely to be female, and had more comorbidities). A total of 135 stent patients were matched to 135 CABG patients on baseline characteristics identified by a propensity model as predictors of type of procedure received. At the end of follow-up on December 31, 2004, the respective 2-year survival rates were 94.1% and 82.0% (hazard ratio = 0.32, p = 0.005) for the 135 pairs of matched CABG and stent patients. The respective 2-year rates for freedom from subsequent revascularization were 93.7% and 62.7% (hazard ratio = 0.15, p < 0.001). In the drug-eluting stent era between October 1, 2003 and December 31, 2004, the same trends in mortality (hazard ratio = 0.73, p = 0.69) and repeat revascularization (hazard ratio = 0.10, p = 0.03) were observed among the 56 pairs of matched CABG and drug-eluting stent patients.
Conclusions:
Most patients with LMCA disease who needed coronary revascularization received CABG surgery; stent patients were sicker. This study found that surgery patients experienced lower risk of long-term death and repeat revascularization. However, more studies comparing these procedures are needed, especially in the drug-eluting stent era.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care