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Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry.
J Am Coll Cardiol. 2010 Oct 19; 56(17):1366-75.JACC

Abstract

OBJECTIVES

This study sought to evaluate the long-term safety and effectiveness of percutaneous coronary intervention (PCI), as compared with coronary artery bypass grafting (CABG), for unprotected left main coronary artery (LMCA) disease.

BACKGROUND

Data on the long-term (beyond 5-year) comparative results of treatment of unprotected LMCA disease with stent implantation or CABG are limited.

METHODS

We performed a 10-year clinical follow-up of 350 patients with unprotected LMCA disease who underwent PCI with bare-metal stents (BMS) (n = 100) or CABG (n = 250) from January 1995 to April 1999, and 5-year clinical follow-up of 395 patients with unprotected LMCA disease who underwent PCI with drug-eluting stents (DES) (n = 176) or CABG (n = 219) from January 2003 to May 2004. The primary safety end points were all-cause mortality and the composite of death, Q-wave myocardial infarction (MI), or stroke, and the primary efficacy end point was target vessel revascularization (TVR).

RESULTS

In the 10-year follow-up cohort of BMS and concurrent CABG, the adjusted risks of death (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.44 to 1.50; p = 0.50) and the composite of death, Q-wave MI, or stroke (HR: 0.92; 95% CI: 0.55 to 1.53; p = 0.74) were similar between the 2 groups. The rate of TVR was significantly higher in the group that received BMS (HR: 10.34; 95% CI: 4.61 to 23.18; p < 0.001). In the 5-year follow-up cohort of DES and concurrent CABG, there was no significant difference in the adjusted risk of death (HR: 0.83; 95% CI: 0.34 to 2.07; p = 0.70) or the risk of the composite outcome (HR: 0.91; 95% CI: 0.45 to 1.83; p = 0.79). The rates of TVR were also higher in the DES group than the CABG group (HR: 6.22; 95% CI: 2.26 to 17.14; p < 0.001).

CONCLUSIONS

For the treatment of unprotected LMCA disease, PCI with stent implantation showed similar long-term mortality and rates of death, Q-wave MI, or stroke. However, stenting, even with DES, was associated with higher rates of repeat revascularization than was CABG.

Authors+Show Affiliations

Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.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 availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20946993

Citation

Park, Duk-Woo, et al. "Long-term Outcomes After Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: 10-year Results of Bare-metal Stents and 5-year Results of Drug-eluting Stents From the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry." Journal of the American College of Cardiology, vol. 56, no. 17, 2010, pp. 1366-75.
Park DW, Kim YH, Yun SC, et al. Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardiol. 2010;56(17):1366-75.
Park, D. W., Kim, Y. H., Yun, S. C., Lee, J. Y., Kim, W. J., Kang, S. J., Lee, S. W., Lee, C. W., Kim, J. J., Choo, S. J., Chung, C. H., Lee, J. W., Park, S. W., & Park, S. J. (2010). Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. Journal of the American College of Cardiology, 56(17), 1366-75. https://doi.org/10.1016/j.jacc.2010.03.097
Park DW, et al. Long-term Outcomes After Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: 10-year Results of Bare-metal Stents and 5-year Results of Drug-eluting Stents From the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardiol. 2010 Oct 19;56(17):1366-75. PubMed PMID: 20946993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. AU - Park,Duk-Woo, AU - Kim,Young-Hak, AU - Yun,Sung-Cheol, AU - Lee,Jong-Young, AU - Kim,Won-Jang, AU - Kang,Soo-Jin, AU - Lee,Seung-Whan, AU - Lee,Cheol-Whan, AU - Kim,Jae-Joong, AU - Choo,Suk-Jung, AU - Chung,Cheol-Hyun, AU - Lee,Jae-Won, AU - Park,Seong-Wook, AU - Park,Seung-Jung, PY - 2009/12/17/received PY - 2010/02/01/revised PY - 2010/03/08/accepted PY - 2010/10/16/entrez PY - 2010/10/16/pubmed PY - 2010/11/3/medline SP - 1366 EP - 75 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 56 IS - 17 N2 - OBJECTIVES: This study sought to evaluate the long-term safety and effectiveness of percutaneous coronary intervention (PCI), as compared with coronary artery bypass grafting (CABG), for unprotected left main coronary artery (LMCA) disease. BACKGROUND: Data on the long-term (beyond 5-year) comparative results of treatment of unprotected LMCA disease with stent implantation or CABG are limited. METHODS: We performed a 10-year clinical follow-up of 350 patients with unprotected LMCA disease who underwent PCI with bare-metal stents (BMS) (n = 100) or CABG (n = 250) from January 1995 to April 1999, and 5-year clinical follow-up of 395 patients with unprotected LMCA disease who underwent PCI with drug-eluting stents (DES) (n = 176) or CABG (n = 219) from January 2003 to May 2004. The primary safety end points were all-cause mortality and the composite of death, Q-wave myocardial infarction (MI), or stroke, and the primary efficacy end point was target vessel revascularization (TVR). RESULTS: In the 10-year follow-up cohort of BMS and concurrent CABG, the adjusted risks of death (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.44 to 1.50; p = 0.50) and the composite of death, Q-wave MI, or stroke (HR: 0.92; 95% CI: 0.55 to 1.53; p = 0.74) were similar between the 2 groups. The rate of TVR was significantly higher in the group that received BMS (HR: 10.34; 95% CI: 4.61 to 23.18; p < 0.001). In the 5-year follow-up cohort of DES and concurrent CABG, there was no significant difference in the adjusted risk of death (HR: 0.83; 95% CI: 0.34 to 2.07; p = 0.70) or the risk of the composite outcome (HR: 0.91; 95% CI: 0.45 to 1.83; p = 0.79). The rates of TVR were also higher in the DES group than the CABG group (HR: 6.22; 95% CI: 2.26 to 17.14; p < 0.001). CONCLUSIONS: For the treatment of unprotected LMCA disease, PCI with stent implantation showed similar long-term mortality and rates of death, Q-wave MI, or stroke. However, stenting, even with DES, was associated with higher rates of repeat revascularization than was CABG. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20946993/Long_term_outcomes_after_stenting_versus_coronary_artery_bypass_grafting_for_unprotected_left_main_coronary_artery_disease:_10_year_results_of_bare_metal_stents_and_5_year_results_of_drug_eluting_stents_from_the_ASAN_MAIN__ASAN_Medical_Center_Left_MAIN_Revascularization__Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03455-8 DB - PRIME DP - Unbound Medicine ER -