Long-Term Safety and Efficacy of Stenting versus Coronary-Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: 5-Year Results from the MAINCOMPARE Registry
1Asan Medical Center, Seoul, Korea (Republic of)
S.J. Park1
Background: Although numerous studies have compared the treatment effects of stenting and coronary-artery bypass grafting (CABG), the long-term (5-year) outcomes among patients with unprotected left main coronary artery (LMCA) disease who underwent coronary stents or CABG have not been evaluated.
Methods: We evaluated 2,240 patients with unprotected LMCA disease who received coronary stents (n=1,102; bare-metal stents [BMS] 318 and drug-eluting stents [DES] 784) or underwent CABG (n=1,138) between 2000 and 2006 and for whom complete follow-up data were available for 3 to 9 years (mean, 5.0 years). We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction [MI], or stroke; and target-vessel revascularization [TVR]) with the use of propensity-score matching.
Results: In the overall-matched cohort (542 pairs), the overall risk of death (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.73 to 1.41, P=0.94) and the combined risk of death, Q-wave MI, or stroke (HR, 1.03; 95% CI, 0.75 to 1.40, P=0.86) were not significantly different for patients undergoing stenting versus CABG. The rates of TVR were significantly higher in the stenting group than in the CABG group (HR, 4.29; 95% CI, 2.73 to 6.74, P<0.001). In comparison of BMS with concurrent CABG (207 pairs), the risk of death (hazard ratio, 1.01; 95% CI, 0.63 to 1.61, P=0.98) and the combined risk of death, Q-wave MI, or stroke (HR, 0.95; 95% CI, 0.61 to 1.48, P=0.81) were not significantly different, whereas the risk of TVR was significantly higher in the BMS group (HR, 6.98; 95% CI, 3.10 to 15.70, P<0.001). In comparison of DES with concurrent CABG (396 pairs), the risks of death (HR, HR 1.27; 95% CI, 0.85 to 1.91, P=0.25) and the combined risk of death, Q-wave MI, or stroke (HR, 1.30; 95% CI, 0.90 to 1.89, P=0.16) did not statistically differ, but the rate of TVR was also significantly higher in the DES group (HR, 6.79; 95% CI, 3.49 to 13.20, P<0.001).
Conclusion: During 5-year follow-up, stenting showed equivalent long-term (5-year) mortality and the rate of death, Q-wave MI, or stroke as compared with CABG for unprotected LMCA disease. However, stenting, even with DES, was associated with higher rates of TVR than was CABG.
