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Impact of Complete or Incomplete Revascularization for Left Main Coronary Disease: The Extended PRECOMBAT Study
Taesun Kim1, Do-Yoon Kang1, Sehee Kim2
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Complete revascularization (CR) versus incomplete revascularization (IR) did not significantly impact 10-year outcomes for left main coronary artery disease patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Both PCI and CABG showed similar long-term results regardless of revascularization completeness.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- The impact of complete revascularization (CR) versus incomplete revascularization (IR) on long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease remains unclear.
- LMCA disease is a critical condition requiring effective revascularization strategies.
Purpose of the Study:
- To assess the 10-year impact of CR or IR on outcomes following PCI or CABG in patients with LMCA disease.
- To compare the long-term efficacy of PCI versus CABG in relation to the completeness of revascularization.
Main Methods:
- The PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial's 10-year extended follow-up was analyzed.
- Patients were randomized to PCI or CABG, and outcomes were evaluated based on CR or IR status.
- The primary outcome was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, stroke, or ischemia-driven target vessel revascularization.
Main Results:
- Among 600 patients, 69.3% achieved CR and 30.7% had IR.
- The 10-year MACCE rates were not significantly different between PCI and CABG for patients with CR (27.8% vs 25.1%) or IR (31.6% vs 21.3%).
- No significant interaction was observed between CR status and the relative effectiveness of PCI versus CABG for MACCE, all-cause mortality, or repeat revascularization.
Conclusions:
- The 10-year outcomes, including MACCE and all-cause mortality, were similar between PCI and CABG, irrespective of CR or IR status in LMCA disease patients.
- These findings suggest that revascularization completeness does not alter the long-term comparative effectiveness of PCI versus CABG for LMCA disease.
Background:
Whether complete revascularization (CR) or incomplete revascularization (IR) may affect long-term outcomes after PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease is unclear.
Objectives:
The authors sought to assess the impact of CR or IR on 10-year outcomes after PCI or CABG for LMCA disease.
Methods:
In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) 10-year extended study, the authors evaluated the effect of PCI and CABG on long-term outcomes according to completeness of revascularization. The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCE) (composite of mortality from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization).
Results:
Among 600 randomized patients (PCI, n = 300 and CABG, n = 300), 416 patients (69.3%) had CR and 184 (30.7%) had IR; 68.3% of PCI patients and 70.3% of CABG patients underwent CR, respectively. The 10-year MACCE rates were not significantly different between PCI and CABG among patients with CR (27.8% vs 25.1%, respectively; adjusted HR: 1.19; 95% CI: 0.81-1.73) and among those with IR (31.6% vs 21.3%, respectively; adjusted HR: 1.64; 95% CI: 0.92-2.92) (P for interaction = 0.35). There was also no significant interaction between the status of CR and the relative effect of PCI and CABG on all-cause mortality, serious composite of death, myocardial infarction, or stroke, and repeat revascularization.
Conclusions:
In this 10-year follow-up of PRECOMBAT, the authors found no significant difference between PCI and CABG in the rates of MACCE and all-cause mortality according to CR or IR status. (Ten-Year Outcomes of PRE-COMBAT Trial [PRECOMBAT], NCT03871127; PREmier of Randomized COMparison of Bypass Surgery Versus AngioplasTy Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT], NCT00422968).
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