Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Background: Up to the guidelines CABG is the prefered therapy for treatment of unprotected left main stenosis. Over the last decade a growing number of patients with this diagnosis have been treated by PCI. There are few long term results comparing both therapies. We present long-term result of a prospective registry of patients with unprotected left main stenosis treated by bypass revascularisation or PCI with drug eluting stents.

Methods: From 04/2003 to 12/2010 1.590 patients with significant left main stenosis were recruited for the study. Patients with cardiogenic shock or acute myocardial infarction were excluded. The dedication of patients to the PCI- or CABG-group carried out at the discretion of the doctor particularly with regard to the baseline variables. Primary endpoint were death, stroke, acute myocardial infarction and reintervention. 246 patients were treated by PCI and 1.344 patients by CABG. There were significant differences in baseline characteristics with respect to age (72.0 vs 68.7 years), gender distribution, left ventricular function, NYHA-class and CCI-class between the PCI- and CABG group. No differences were seen in history of myocardial infarction, stroke, diabetes, hyperlipidemia, smoking and medication.

Mean follow-up period was 3.8 years. We evaluated the results with propensity score analysis.

Results: All patients received a complete revascularisation. We observed a low peri-interventional mortality of 0.4% in the PCI-group and 3.1% in the CABG-group.

Over a cumulative period of 43 month, 24 pat. (12.4%) from the PCI-group and 228 pat. (21.0%) from CABG-cohort died. The stroke rate was 3.6% in both groups. 2.4% and 1.5% (PCI-/CABG-group) had a myocardial infarction. Target vessel revascularisation (TVR) rate was considerably higher for the PCI-cohort (23.9% vs 11.5%, p < 0.001).

After adjustment of confounding variables there were no differences in the combined endpoint of death, stroke, myocardial infarction and TVR (p =0.092). For itemised endpoint analysis, only TVR was significant different to the disadvantage of PCI. There was a trend for lower mortality in the PCI-group (p=0.053).

Conclusion: In patients with unprotected left main stenosis both CABG and PCI with DES can be performed with little procedural risk. Also for a longer follow up period of nearly 4 years, the rate for Death, Stroke and MI did not differ between PCI and CABG. TVR rate was significant higher in PCI group.

This content is only available as a PDF.
The European Society of Cardiology
Topic:
Issue Section:
Abstracts
You do not currently have access to this article.
Download all slides