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Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location

Junho Hyun1, Ju Hyeon Kim1, Yeongjin Jeong1

  • 1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

JACC. Cardiovascular Interventions
|December 28, 2020
PubMed

Insights

Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) for distal left main coronary artery bifurcation disease beyond five years. Outcomes were similar for ostial or shaft disease regardless of treatment.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Limited long-term comparative data exist for percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in left main coronary artery (LMCA) disease, specifically concerning lesion site.
  • Understanding lesion site impact is crucial for optimizing revascularization strategies in LMCA disease.

Purpose of the Study:

  • To investigate the influence of LMCA lesion location (ostial/shaft vs. distal bifurcation) on long-term outcomes following PCI or CABG.
  • To compare the efficacy and safety of PCI versus CABG based on LMCA lesion site.

Main Methods:

  • Analysis of patients from the MAIN-COMPARE registry comparing adverse outcomes between PCI and CABG.
  • Outcomes assessed included all-cause mortality and target vessel revascularization over a median follow-up of 12.0 years.
  • Stratification of analysis based on LMCA lesion location: ostial/shaft versus distal bifurcation.

Main Results:

  • For distal LMCA bifurcation disease, PCI demonstrated higher adjusted risks for death and a serious composite outcome compared to CABG, particularly after 5 years.
  • Drug-eluting stents (DES) showed progressively diverging risks for death and composite outcomes compared to CABG for distal bifurcation disease beyond 5 years.
  • No significant differences in outcomes were observed between PCI and CABG for ostial or shaft LMCA disease.

Conclusions:

  • CABG is associated with lower long-term mortality and serious composite outcome rates compared to DES for distal LMCA bifurcation disease.
  • For ostial or shaft LMCA disease, PCI and CABG demonstrate similar long-term safety and efficacy.
  • The findings highlight the importance of lesion site in guiding treatment decisions for LMCA disease.
Abstract

Keywords:
cardiovascular eventscoronary artery bypass graftingleft main coronary artery diseasemortalitypercutaneous coronary intervention

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