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Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.
J Am Coll Cardiol. 2006 Feb 21; 47(4):864-70.JACC

Abstract

OBJECTIVES

This study evaluated the clinical outcomes of consecutive, selected patients treated with coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (ULMCA) disease.

BACKGROUND

Although recent data suggest that PCI with DES provides better clinical outcomes compared to bare-metal stenting for ULMCA disease, there is a paucity of data comparing PCI with DES to CABG.

METHODS

Since April 2003, when DES first became available at our institution, 123 patients underwent CABG, and 50 patients underwent PCI with DES for ULMCA disease.

RESULTS

High-risk patients (Parsonnet score >15) comprised 46% of the CABG group and 64% of the PCI group (p = 0.04). The 30-day major adverse cardiac and cerebrovascular event (MACCE) rate for CABG and PCI was 17% and 2% (p < 0.01), respectively. The mean follow-up was 6.7 +/- 6.2 months in the CABG group and 5.6 +/- 3.9 months in the PCI group (p = 0.26). The estimated MACCE-free survival at six months and one year was 83% and 75% in the CABG group versus 89% and 83% in the PCI group (p = 0.20). By multivariable Cox regression, Parsonnet score, diabetes, and CABG were independent predictors of MACCE.

CONCLUSIONS

Despite a higher percentage of high-risk patients, PCI with DES for ULMCA disease was not associated with an increase in immediate or medium-term complications compared with CABG. Our data suggest that a randomized comparison between the two revascularization strategies for ULMCA may be warranted.

Authors+Show Affiliations

Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, Los Angeles, California 90048, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16487857

Citation

Lee, Michael S., et al. "Comparison of Coronary Artery Bypass Surgery With Percutaneous Coronary Intervention With Drug-eluting Stents for Unprotected Left Main Coronary Artery Disease." Journal of the American College of Cardiology, vol. 47, no. 4, 2006, pp. 864-70.
Lee MS, Kapoor N, Jamal F, et al. Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol. 2006;47(4):864-70.
Lee, M. S., Kapoor, N., Jamal, F., Czer, L., Aragon, J., Forrester, J., Kar, S., Dohad, S., Kass, R., Eigler, N., Trento, A., Shah, P. K., & Makkar, R. R. (2006). Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease. Journal of the American College of Cardiology, 47(4), 864-70.
Lee MS, et al. Comparison of Coronary Artery Bypass Surgery With Percutaneous Coronary Intervention With Drug-eluting Stents for Unprotected Left Main Coronary Artery Disease. J Am Coll Cardiol. 2006 Feb 21;47(4):864-70. PubMed PMID: 16487857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease. AU - Lee,Michael S, AU - Kapoor,Nikhil, AU - Jamal,Faizi, AU - Czer,Lawrence, AU - Aragon,Joseph, AU - Forrester,James, AU - Kar,Saibal, AU - Dohad,Suhail, AU - Kass,Robert, AU - Eigler,Neal, AU - Trento,Alfredo, AU - Shah,Prediman K, AU - Makkar,Raj R, Y1 - 2006/01/06/ PY - 2005/06/16/received PY - 2005/08/10/revised PY - 2005/09/08/accepted PY - 2006/2/21/pubmed PY - 2006/4/29/medline PY - 2006/2/21/entrez SP - 864 EP - 70 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 47 IS - 4 N2 - OBJECTIVES: This study evaluated the clinical outcomes of consecutive, selected patients treated with coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (ULMCA) disease. BACKGROUND: Although recent data suggest that PCI with DES provides better clinical outcomes compared to bare-metal stenting for ULMCA disease, there is a paucity of data comparing PCI with DES to CABG. METHODS: Since April 2003, when DES first became available at our institution, 123 patients underwent CABG, and 50 patients underwent PCI with DES for ULMCA disease. RESULTS: High-risk patients (Parsonnet score >15) comprised 46% of the CABG group and 64% of the PCI group (p = 0.04). The 30-day major adverse cardiac and cerebrovascular event (MACCE) rate for CABG and PCI was 17% and 2% (p < 0.01), respectively. The mean follow-up was 6.7 +/- 6.2 months in the CABG group and 5.6 +/- 3.9 months in the PCI group (p = 0.26). The estimated MACCE-free survival at six months and one year was 83% and 75% in the CABG group versus 89% and 83% in the PCI group (p = 0.20). By multivariable Cox regression, Parsonnet score, diabetes, and CABG were independent predictors of MACCE. CONCLUSIONS: Despite a higher percentage of high-risk patients, PCI with DES for ULMCA disease was not associated with an increase in immediate or medium-term complications compared with CABG. Our data suggest that a randomized comparison between the two revascularization strategies for ULMCA may be warranted. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16487857/Comparison_of_coronary_artery_bypass_surgery_with_percutaneous_coronary_intervention_with_drug_eluting_stents_for_unprotected_left_main_coronary_artery_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)03037-8 DB - PRIME DP - Unbound Medicine ER -