Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously in JACC) was to achieve a 10-year follow-up (median: 12 years).
The MAIN COMPARE registry included 2240 patients with LMCA lesions (1102 who underwent angioplasty and 1138 who underwent surgery) between 2000 and 2006. Among all angioplasty patients, about 318 received conventional stents.
The primary endpoint was a composite of death, infarction, stroke, and target-vessel revascularization. Different statistical tools were used for population comparison.
In the overall cohort, there was no significant difference as regards death, infarction, or stroke, but there were differences regarding revascularization, particularly taking into account that around 30% of patients received conventional stents.
Read also: TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation.
As regards the cohort of patients who received drug-eluting stents (DES), there was no difference in the combined endpoint at 5 years, even though, beyond that period, patients who underwent angioplasty were at a higher risk of death and combined events than those who underwent surgery. Such a difference disappeared once populations were compared after propensity score matching, as it had been previously specified.
Original title: Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease.
Presenter: Seung-Jung Park.
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