Comparison of coronary artery bypass grafting with percutaneous coronary intervention for unprotected left main...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Left main coronary artery disease (LMCAD) is a critical condition requiring careful treatment decisions.
• Coronary artery bypass grafting (CABG) is traditionally considered optimal, but percutaneous coronary intervention (PCI) is an alternative.
• Ongoing debate exists between cardiac surgeons and interventional cardiologists regarding the best approach for LMCAD.

Purpose of the Study:

• To compare the mid-term efficacy of CABG versus PCI for treating unprotected LMCAD.
• To evaluate outcomes including death, stroke, and acute coronary syndrome (ACS).
• To assess the role of drug-eluting stents (DESs) in PCI for LMCAD.

Main Methods:

• A study of 199 consecutive patients with unprotected LMCAD.
• Patients were allocated to either PCI (88 patients) or CABG (111 patients).
• Primary endpoints included mortality, stroke, and ACS.

Main Results:

• PCI patients had a higher operative risk (6.49 ± 4.09) compared to CABG patients (4.81 ± 2.67).
• No significant difference in major adverse cardio-cerebral events (MACCE) between DES and CABG groups.
• Mortality rates were similar between CABG and PCI groups (11% vs. 16%), but higher in CABG than DES (11% vs. 3%).
• The rate of ACS was significantly higher in the PCI group (13%) compared to the CABG group (4%).

Conclusions:

• PCI with DES demonstrates comparable mid-term outcomes to CABG regarding mortality, stroke, and ACS in LMCAD patients.
• Despite higher initial operative risk, PCI with DES is a viable alternative.
• The need for repeat revascularizations remains a significant concern for PCI in LMCAD treatment.