10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left€Main€Coronary€Artery Disease

ISS Fro Me of Sa Ho Ko Na Ah So Ma BACKGROUND Comparative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease were previously reported. However, data on very long-term (>10 years) outcomes are limited. OBJECTIVES The authors compare 10-year outcomes after PCI and CABG for LMCA disease. METHODS In this observational studyof theMAIN-COMPARE (Revascularization forUnprotectedLeftMainCoronaryArtery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization) registry, the authors evaluated 2,240 patientswith unprotected LMCA disease who underwent PCI (n1⁄4 1,102) or underwent CABG (n1⁄4 1,138) between January 2000 and June 2006. Adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) were compared with the use of propensity scores and inverse-probabilityweighting adjustment. The follow-up was extended to at least 10 years of all patients (median 12.0 years). RESULTS In the overall cohort, there was no significant difference in adjusted risks of death and the composite outcome between the groups up to 10 years. The risk of target-vessel revascularization was significantly higher in the PCI group. In the cohort comparing drug-eluting stents and concurrent CABG, the 2 study groups did not differ significantly in the risks of death and the composite outcome at 5 years. However, after 5 years, drug-eluting stents were associated with higher risks of death (hazard ratio: 1.35; 95% confidence interval: 1.00 to 1.81) and the composite outcome (hazard ratio: 1.46; 95% confidence interval: 1.10 to 1.94) compared with CABG. CONCLUSIONS In patients with significant LMCA disease, as compared with CABG, PCI showed similar rates of death and serious composite outcomes, but a higher rate of target-vessel revascularization at 10 years. However, CABG showed lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years. (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularization [MAIN-COMPARE]; NCT02791412) (J Am Coll Cardiol 2018;72:2813–22) © 2018 by the American College of Cardiology Foundation. N 0735-1097/$36.00 https://doi.org/10.1016/j.jacc. 2018.09. 012 m the Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan dical Center, Seoul, Korea; Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, St. Mary’s Hospital, GangNam, Seoul, Korea; msung Medical Center, Seoul, Korea; Chonnam National University Hospital, Gwangju, Korea; Yonsei University Severance spital, Seoul, Korea; Seoul National University Hospital, Seoul, Korea; Chungnam National University Hospital, Daejeon, rea; Kyung Pook National University Hospital, Daegu, Korea; Gachon University Gil Medical Center, Incheon, Korea; Seoul tional University Hospital, Bundang, Korea; and the Ajou University Medical Center, Suwon, Korea. *Drs. D. -W. Park and J.-M. n contributed equally to this work. This work was partly supported by grants from the Cardiovascular Research Foundation of uth Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. nuscript received August 7, 2018; revised manuscript received September 12, 2018, accepted September 12, 2018. ABBR EV I A T I ON S AND ACRONYMS BMS = bare-metal stent(s) CABG = coronary artery bypass grafting CI = confidence interval DES = drug-eluting stent(s)