Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting

Figures & data

Table I.  Characteristics of the study patients.

	PCI (n=49)	CABG (n=238)	P-value
Clinical features
Age (years)	72±10	70±9	0.006
Gender—male/female	29/20 (59/41%)	190/48 (80/20%)	<0.001
Smoking (current)	10 (20%)	43 (18%)	0.698
Diabetes	10 (20%)	40 (17%)	0.711
Hypertension	23 (46%)	108 (46%)	0.698
CCS class (II/III/IV)	7/22/18	50/99/89	0.471
Prior PCI	3 (6%)	8 (3%)	0.365
LVEF	55±12	54±11	0.541
Cholesterol (mmol/L)	4.6±0.9	4.7±0.9	0.691
Low Density Lipoprotein (mmol/L)	2.7±0.9	2.9±1.0	0.385
Medication
Aspirin	44 (90%)	195 (82%)	0.121
Beta-blockers	44 (90%)	190 (80%)	0.024
Statins	41 (84%)	173 (73%)	0.012
ACE inhibitors/AT II blockers	25 (51%)	88 (37%)	0.114
Ca-channel blockers	9 (18%)	21 (9%)	0.145
Status prior procedure:
Euroscore	7.7±7.5	5.2±4.4	0.002
Elective/UAP/AMI	23/13/13 (47/27/27%)	65/113/60 (27/47/25%)	0.037

ACE = angiotensin-converting enzyme; AMI = acute myocardial infarction; AT II = angiotensin II receptor; CCS = Killip class; LDL = low density lipoprotein;LVEF = left ventricular ejection fraction; PCI = percutaneous coronary intervention; UAP = unstable angina pectoris.

Table II.  Procedural characteristics of the patients.

	PCI (n=49)
Lesion type; ostial/distal	10/39
Stent deployment technique:
Single stent	20 (41%)
Culotte/crush	24 (49%)
Provisional T	5 (10%)
Final stent diameter	3.9±0.7
Glycoprotein inhibitors	29 (59%)
Guidance with IVUS	29 (59%)
	CABG (n=238)
Number of grafts	3.7±0.9
On-pump/off-pump	114/124

CABG = coronary artery bypass grafting; IVUS = intravascular ultra sound; PCI = percutaneous coronary intervention.

Figure 1.  Kaplan-Meier survival curve for death among patients with percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) treatment for left main coronary artery stenosis. Patients with PCI had nonsignificant tendency to lower death rate than patients treated with CABG during the follow-up.

Table III.  Outcomes during the mean follow-up of 12 months.

	PCI	CABG	P-value
Death (30 days)	1 (2%)	15 (6%)	0.133
Death (follow-up)	2 (4%)	25 (11%)	0.136
Stroke	0 (0%)	12 (5%)	0.082
ST-elevation myocardial infarction	1 (2%)	4 (2%)	0.861
Symptom-based new revascularization	2 (4%)	4 (2%)	0.285
Primary or secondary end point event ^a	5 (10%)	49 (20%)	0.044

^a Primary or secondary end point: death, stroke, ST-elevation myocardial infarction, symptom-based new revascularization, or unplanned new hospitalization.

CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.

Table IV.  Cox proportional hazard model results using death as an end point.

	Hazard ratio (95% CI)	P-value
Univariate analysis
Left ventricular function (EF < 40%)	14.9 (5.5–40.0)	<0.001
COPD	3.1 (1.2–8.2)	0.021
Age (>70 years)	1.5 (0.7–3.2)	0.279
High preoperative risk score (Euroscore > 6)	1.6 (5.6–3.6)	0.245
Urgent revascularization (ACS or UAP)	1.5 (0.6–3.6)	0.416
CABG versus PCI treatment	2.7 (0.6–3.7)	0.179
Multivariate analysis (adjusted by medication, EF and ACS)
COPD	2.1 (0.7–6.8)	0.176
Age (>70 years)	1.3 (0.6–2.8)	0.571
CABG versus PCI treatment	2.5 (0.6–10.8)	0.227

ACS = acute coronary syndrome; CABG = coronary artery bypass grafting; COPD = chronic obstructive pulmonary disease; EF = ejection fraction; PCI = percutaneous coronary intervention; UAP = unstable angina pectoris.

Table V.  Cox proportional hazard model results using any primary or secondary event as an end point.

	Hazard ratio (95% CI)	P-value
Univariate analysis
Left ventricular function (EF < 40%)	4.6 (2.6–8.1)	<0.001
COPD	2.7 (1.2–5.6)	0.024
Age (>70 years)	1.2 (0.7–2.0)	0.587
High preoperative risk score (Euroscore > 6)	1.8 (1.1–3.1)	0.033
Urgent revascularization (ACS or UAP)	1.7 (0.8–3.4)	0.108
CABG versus PCI treatment	2.0 (0.8–4.9)	0.113
Multivariate analysis (adjusted by medication, EF, and ACS)
COPD	2.2 (0.8–5.9)	0.086
Age (>70 years)	1.1 (0.6–2.0)	0.811
CABG versus PCI treatment	2.1 (0.7–5.8)	0.180

ACS = acute coronary syndrome; CABG = coronary artery bypass grafting; COPD = chronic obstructive pulmonary disease; EF = ejection fraction; PCI = percutaneous coronary intervention; UAP = unstable angina pectoris.