Unprotected left main coronary artery disease in patients with low predictive risk of mortality
Shun Watanabe1, Tatsuhiko Komiya, Genichi Sakaguchi
1Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
Insights
Coronary artery bypass grafting (CABG) is recommended over drug-eluting stent (DES) percutaneous coronary intervention for unprotected left main coronary artery disease. CABG showed better outcomes, particularly for lower-risk patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Increasing use of drug-eluting stents (DES) for unprotected left main coronary artery disease (ULMICAD).
- Need to compare outcomes of coronary artery bypass grafting (CABG) versus DES PCI in ULMICAD patients.
Purpose of the Study:
- To assess the superiority of CABG compared to first-generation DES PCI in patients with ULMICAD.
- To evaluate clinical outcomes, including survival and adverse events, in ULMICAD patients treated with either CABG or DES PCI.
Main Methods:
- Retrospective analysis of 295 ULMICAD patients (2003-2007) at Kurashiki Central Hospital.
- Comparison of CABG (n=169) versus DES PCI (n=126) groups.
- Stratification by Society of Thoracic Surgeons' (STS) predicted risk of mortality score (higher/lower than 2.3%).
- Kaplan-Meier analysis for survival, major adverse cardiac-related events, and target lesion revascularization.
Main Results:
- CABG demonstrated lower rates of major adverse cardiac-related events and target lesion revascularization compared to DES PCI in both risk strata.
- Patients undergoing CABG showed significantly higher cardiac death-free survival rates, especially in the lower-risk STS score group.
Conclusions:
- Coronary artery bypass grafting (CABG) is recommended for unprotected left main coronary artery disease.
- CABG offers superior outcomes, particularly for patients with lower predicted mortality risk (STS score < 2.3%).
- This single-center, 5-year experience supports CABG as the preferred revascularization strategy for ULMICAD.
Background:
There has been an increasing use of percutaneous coronary intervention with drug-eluting stent (DES) in patients with unprotected left main coronary artery disease. We assessed whether coronary artery bypass grafting (CABG) would be superior to percutaneous coronary intervention with first-generation DES in patients with unprotected left main coronary artery disease.
Methods:
Between January 2003 and December 2007, a total of 295 patients with unprotected left main coronary artery disease were treated with Kurashiki Central Hospital, Okayama, Japan. Among these patients, 169 and 126 underwent CABG and percutaneous coronary intervention with DES, respectively. The average Society of Thoracic Surgeons' predictive risk of mortality score was 2.3±3.8%. We defined higher-risk and lower-risk patients as those with Society of Thoracic Surgeons' predictive risk of mortality scores higher than 2.3% (CABG, n=48; percutaneous coronary intervention, n=28) and lower than 2.3% (CABG, n=121; percutaneous coronary intervention, n=98), respectively. Survival, major adverse cardiac-related events, and target lesion revascularization were analyzed by the Kaplan-Meier method.
Results:
Between-group differences in favor of CABG were seen with respect to the rate of major adverse cardiac-related events and target lesion revascularization in both strata. In patients with lower scores according to the Society of Thoracic Surgeons' predictive risk of mortality, the cardiac death-free survival rate was significantly higher in CABG.
Conclusions:
In this 5-year single-center experience, CABG is recommended for unprotected left main coronary artery disease, especially in patients with low scores in the Society of Thoracic Surgeons' predictive risk of mortality.
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