In-hospital and long-term results of unprotected left main stenting versus coronary artery bypass grafting - A single center experience in Taiwan

Background: The status of percutaneous coronary intervention (PCI) for the treatment of left main coronary artery (LMCA) disease remains undetermined, and relatively few data on Taiwanese population has been published. Method: Between March, 2003 and October, 2008, 121 patients with de-novo significant LMCA disease were included into this study. Eighty-seven patients received coronary artery bypass surgery (CABG) for LMCA disease, and 34 patients received PCI for LMCA disease. Significant LMCA disease was defined as at least > 50% stenosis of the left main coronary artery. The differences of clinical outcomes between the two treatment strategies were compared with respect to the in-hospital major adverse events rate and long-term major adverse cardiovascular and cerebrovascular events (MACCE) rate. Results: There were no significant differences in terms of baseline characteristics between the two groups. The overall all-cause mortality with MACCE was 32.2% in the CABG group, and 35.3% in the PCI group (p = 0.74). The overall mortality throughout the study period was 17.2% in the CABG group, and 5.9% in the PCI group (p = 0.09). The CABG group had significantly higher in-hospital major adverse event rates (27.6%) than the PCI group (8.8%) (p = 0.02) after adjustment of potential covariates. Long-term cumulative MACCE rates were 15% in the CABG group, and 32.4% in the PCI group, respectively (p = 0.02). The lower MACCE rate in the CABG group was mainly due to lower revascularization rate in the CABG group than in the PCI group (8.8% vs. 29.4%; p < 0.01). Conclusion: The CABG group conferred significantly higher in-hospital major adverse event rate but significantly lower long-term MACCE rate in patients with significant LMCA disease. The CABG group displayed numerically higher incidence of all-cause mortality throughout the study period. PCI could be considered an alternative option for patients with unprotected LMCA disease.