Outcomes of Left Main Revascularization after Percutaneous Intervention or Bypass Surgery

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Unprotected left main coronary artery disease (ULMCAD) poses significant treatment challenges.
• Treatment decisions involve balancing risks and benefits of revascularization strategies.
• Real-world data is crucial for understanding outcomes in diverse patient populations.

Purpose of the Study:

• To compare clinical outcomes of contemporary percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for ULMCAD.
• To evaluate treatment efficacy in a real-world patient cohort.
• To identify predictors of long-term outcomes in ULMCAD patients.

Main Methods:

• Retrospective analysis of 558 consecutive ULMCAD patients undergoing PCI or CABG.
• Primary endpoint: composite of death, myocardial infarction, or stroke up to 4 years.
• Propensity score matching and multivariate analysis were employed to adjust for confounding factors.

Main Results:

• No significant difference in the primary composite endpoint between PCI and CABG groups (15.5% vs. 17.1%, p=0.585).
• Ischemia-driven revascularization was more frequent after PCI compared to CABG (5.5% vs. 1.5%, p=0.010).
• Diabetes mellitus and EuroSCORE were independent predictors of adverse long-term outcomes.

Conclusions:

• Contemporary PCI and CABG demonstrate similar long-term clinical outcomes for ULMCAD in real-world practice.
• Treatment strategy choice may not significantly impact major adverse events regardless of coronary complexity.
• Patient comorbidities like diabetes and pre-procedural risk scores (EuroSCORE) are critical determinants of prognosis.