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Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Left Main Coronary Artery

Szymon Jonik1, Karolina Gumiężna1, Piotr Baruś1

  • 11st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland.

Journal of Clinical Medicine
|August 28, 2025
PubMed

Insights

For left main coronary artery (LMCA) disease, 5-year outcomes show similar overall mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). CABG had more strokes, while PCI had more myocardial infarctions and repeat revascularizations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Optimal revascularization for left main coronary artery (LMCA) disease remains debated, with limited real-world data.
  • Randomized controlled trials (RCTs) provide evidence, but clinical practice outcomes require further investigation.
  • This study evaluates 5-year outcomes in patients with multivessel coronary artery disease (MVD) involving LMCA.

Purpose of the Study:

  • To compare 5-year clinical outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for LMCA disease.
  • To assess overall mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stroke, and repeat revascularization (RR).
  • To analyze real-world data from patients treated according to Heart Team (HT) recommendations.

Main Methods:

  • Retrospective analysis of 267 patients with MVD involving LMCA disease.
  • Patients were treated with either CABG (109 patients) or PCI (158 patients) between 2016-2019.
  • Outcomes assessed included all-cause mortality, MACCE, MI, stroke, and RR at 5-year follow-up.

Main Results:

  • No significant difference in 5-year overall mortality between CABG and PCI groups (22.9% vs. 24.7%, p=0.74).
  • Higher rates of myocardial infarction (MI) in the PCI group (15.8% vs. 7.3%, p=0.04).
  • Higher rates of stroke in the CABG group (11.0% vs. 3.8%, p=0.02).
  • Higher MACCE rates in the PCI group (77.2% vs. 55.0%, p<0.001), driven by significantly higher rates of repeat revascularization (RR) (32.9% vs. 13.8%, p<0.001).

Conclusions:

  • In real-world practice, neither CABG nor PCI demonstrated overwhelming superiority for LMCA disease management.
  • CABG was associated with higher stroke rates, while PCI led to more MIs and repeat revascularizations.
  • Heart Team decisions guide treatment, with similar long-term survival but differing event profiles between revascularization strategies.

Keywords:
Heart Teamcoronary artery diseaseleft main coronary artery diseasemultivessel coronary artery diseasepercutaneous coronary intervention

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