Premium
Comparative long‐term efficacy and safety of drug‐eluting stent versus coronary artery bypass grafting in ostial left main coronary artery disease
Author(s) -
Lee SeungWhan,
Kim SungHwan,
Kim SeonOk,
Han Seungbong,
Kim YoungHak,
Park DukWoo,
Kang SooJin,
Lee Cheol Whan,
Park SeongWook,
Park SeungJung
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23369
Subject(s) - medicine , cardiology , hazard ratio , percutaneous coronary intervention , conventional pci , myocardial infarction , stroke (engine) , drug eluting stent , propensity score matching , revascularization , artery , confidence interval , stent , coronary artery disease , proportional hazards model , surgery , mechanical engineering , engineering
Background : To date, drug‐eluting stent (DES) implantation has not been compared with coronary artery bypass grafting (CABG) for ostial left main coronary artery (LMCA) lesions. Methods : Of the 263 patients in the MAIN‐COMPARE registry with ostial LMCA stenosis, 123 were treated with percutaneous coronary intervention (PCI) with DES and 140 with CABG. We compared their 5‐year overall survival, composite outcomes of death, Q‐wave myocardial infarction (MI) or stroke, and target vessel revascularization (TVR) rates. Results : Unadjusted analysis showed no significant differences between CABG and DES in overall survival rates (95% confidence interval (CI) for hazard ratio (HR): 0.44 to 1.77, P = 0.71), composite outcomes (death, Q‐wave MI, or stroke)‐free survival rates (95% CI for HR: 0.41–1.63, P = 0.56), and TVR‐free survival rates (95% CI for HR: 0.79–5.03, P = 0.14). Multivariate adjusted Cox regression analysis also showed no significant between‐group differences in TVR (95% CI for HR: 0.52–3.79, P = 0.49), death (95% CI for HR: 0.79–2.82, P = 0.22) and the composite of death, Q‐wave MI, or stroke (95% CI for HR: 0.65–2.57, P = 0.46). These results were sustained after propensity score adjustment and propensity score matching analysis. Conclusions : DES implantation for ostial LMCA lesions showed similar 5‐year outcomes of death, major adverse events, and TVR compared with CABG. Although meticulous adjustments decreased baseline difference between the two treatments, the absence of statistical significance could be attributable to the size of the study sample and hidden bias. © 2012 Wiley Periodicals, Inc.