Comparison Between Drug-Eluting Stents And Coronary Artery Bypass Surgery For The Treatment Of Unprotected Left Main Coronary Artery Stenosis

Objective:To evaluate the clinical outcomes of patients treated with coronary artery bypass grafting surgery or percutaneous coronary intervention with drug-eluting stents for unprotected left main disease and find out the better choice of revascularization for such kind of patients.Methods:This study was a retrospective cohort study.From August 2004 to March 2006,a total of 115 patients with unprotected left main disease received revascularization in Zhongshan Hospital,Fudan University.Sixty-six of them underwent CABG(CABG group) and forty-nine received drug-eluting stents(PCI group).Baseline features,angiograpbic characteristics and operation data were recorded at entry point.The clinical end point was MACCE(major adverse cardiac and cerebrovascular event),including death of all causes,myocardial infarction,stroke and target vessel revascularization.All analysis was performed using the SPSS 17.0. Survival curves were computed by the Kaplan-Meier method and compared with the Log-rank test.Cox regression was used for multivariate analysis of prognostic factors.Results:1.Patients in the CABG group were older and had more diabetes mellitus, hypertension,myocardial infarction and heart failure than that in the PCI group.The average Euroscore of the CABG group was higher than that of the PCI group.More patients in the CABG group had distal LMCA stenosis and coupled 3-vessel disease.2.The combination of death,myocardial infarction,stroke,and target vessel revascularization(MACCEs) at 30 days occurred in 9.09%of the patients in the CABG group,but there was none MACCE in the PCI group.3.There were more target vessel revascularization events in the PCI group than in the CABG group at 1 year(22.9%vs.3.6%;P=0.006),although MACCE-free rate was similar(84.2%CABG vs.77.6%DES,P=0.483). Moreover,there were no significant differences of survival rate(87.1% CABG vs.92.2%DES,P=0.441) or MACCE-free rate(69.9%CABG vs.58.0% DES,P=0.262) at a long-term follow-up,but the rVR-free rate was still lower in the DES group(62.8%DES vs.94.5%CABG,P＜0.001).4.Cox regression analysis indicated that CABG had a better outcome in patients with low-risk(Euroscore＜6) and distal LMCA stenosis.The hazard ratio was 0.320(95%CI 0.135-0.758,P=0.01) in patients with low risk and 0.373(95%CI 0.165-0.843,P=0.018) in patients with distal LMCA stenosis.Conclusion:Despite a higher percentage of high-risk patients in the CABG group, the long-term follow-up showed no difference in the rate of death, myocardial infarction,stroke and MACCE between PCI withDES and CABG for the treatment of unprotected left main coronary artery stenosis.However, the rate of target vessel revascularization was higher in the PCI group than that in the CABG group.In patients with low-risk and distal LMCA stenosis,CABG is a better choice.