Comparison of Coronary Artery Bypass Grafting with Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease

Abstract

PurposeCoronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs).Materials and MethodsThe study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS).ResultsPatients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49±4.09 vs. 4.81±2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016).ConclusionDespite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

“…26 Atrial fibrillation has been found consistently to increase stroke rate in various clinical settings and is therefore likely an important mechanism of late stroke after either procedure. 27,28 The risk of adverse cerebrovascular events with each repeat revascularization is likely additive. Interventions on the vein grafts have been shown to be predictive of post-PCI strokes.…”

The Assessment of Percutaneous Coronary Angioplasty versus Coronary Artery Bypass Grafting in Treatment of Left Main Coronary Artery Disease

“…In the past decades percutaneous coronary intervention (PCI) has been used as an alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease [1,2]. Despite the increase in PCI, CABG has shown superiority in patients with left main coronary artery disease [1][2][3].…”

“…The incidence of left main coronary artery disease (LMCAD) among patients who are explored by coronary angiography is approximately 6%, with a range of 4-9% [3,4].…”

“…Although not very common, according to the incidence described above, LMCAD continues to remain a problem between interventional cardiologists and cardiac surgeons in treating this type of disease [3]. This topic began in 1975, when Gorlin and Cohen were the first to compare LMCAD's surgical treatment with other therapeutic alternatives, highlighting the superiority of CABG over drug therapies [5].…”

Long-term Clinical and Angiographic Results of Recanalization of Small Diameter Coronary Arteries in Patients with Ischemic Heart Disease

“…При цьому слід зазначити, що черезшкірні ен-доваскулярні коронарні втручання здатні забезпе-чити адекватну реваскуляризацію міокарда [6] і в значній мірі зменшити потребу в хірургічному коро-нарному шунтуванні, а у деяких пацієнтів бути пов-ноцінною альтернативою аортокоронарному шун-туванню [7].…”