Comparsion Of Revascularization For Unprotected Left Main Coronary Artery Stenosis

Background:For coronary artery disease with unprotected left main coronary artery (ULMCA)stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the “standardof care” because of its well-documented and durable survival advantage. Improvedoutcomes of percutaneous coronary interventions (PCI) with drug-eluting stents (DES)have resulted in their expanded use for left main coronary artery stenosis. PCI with DESwas found to be a viable alternative to CABG.Objective:This study was designed to evaluate the clinical outcomes of patients treated withcoronary artery bypass graft surgery or percutaneous coronary interventions withdrug-eluting stents for unprotected left main coronary artery disease.Methods:This study was a retrospective cohort study. We evaluated59patients underwent PCIwith DES (DES group) and37patients underwent CABG (CABG group) for unprotectedleft main coronary artery disease in the first affiliated hospital of soochow university sinceDecember2006to December2011. The clinical and CAG information were collected andstudied. The incidences of major adverse cardiac and cerebrovascular events (MACCE)were recorded.Results：1. The clinical characteristics were comparable between the two groups. The averageEUROscore of the DES group was higher than than the CABG group（P>0.05）. Theaverage SYNTAXscore of the CABG group was higher than the DES group（P<0.05）.2. The mean follow-up was (29.51±11.34) months, the short-outcome in the DES was superior to CABG（P＜0.05）. The estimated MACCE-free survival at2years was76.7%in the DES group versus56.2%in the CABG group (P>0.05).3. The MACCE-free survival at2years in the left main only and left main plussingle-vessel disease group and the left main plus double-vessel and triple-vessel diseasegroup was94.8%and70.3%.Patients with the distal-bifurcation stenosis were more likelyto have higher MACCE-free rate than non-bifurcation stenosis.Conclusion:Patients with ULMCA disease treated with PCI or CABG had favorable immediate andlongtime outcomes. SYNTAXscore was a useful tool to predict the outcomes of treatments.when the patients with high SYNTAXscore,CABG is superior to stenting. The anti-platelettherapy helped to reduce cerebrovascular events.