Angioplasty and myocardial revascularization surgery have competed over the left main coronary artery for a long time. There may be many points of view involved in the interpretation of trial outcomes. While surgeons consider the left main coronary artery to be suitable for surgery (except when faced with surgical contraindications), interventional cardiologists see the left main coronary artery as feasible for angioplasty, with similar outcomes in hard endpoints such as mortality.
The MAIN COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) registry included 2240 patients with unprotected left main coronary artery disease who underwent angioplasty (n=1102) or myocardial revascularization surgery (n=1138) between 2000 and 2006.
Endpoints such as death; a composite of death, infarction, or stroke; and target-vessel revascularization were compared with the use of propensity scores.
Read also: TCT 2018 | MAIN COMPARE: Angioplasty vs. Surgery for Left Main Coronary Artery Disease at 10 Years.
The follow-up was at least 10 years for all patients (median 12.0 years).
In the global cohort, there were no significant differences after all adjustments in the risk of death and the composite endpoint between the groups at 10 years.
Unsurprisingly, the risk of target-vessel revascularization was significantly higher in the angioplasty group.
Read also: EXCEL Outcomes: PCI vs CABG in Patients with Prior Cerebrovascular disease.
Comparing only patients who received drug-eluting stents, there were no significant differences in the risk of death and the composite endpoints at 5 years. However, at that timepoint, curves started to separate in favor of myocardial revascularization surgery, in terms of both mortality (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.81) and the composite endpoints (HR: 1.46; 95% CI: 1.10 to 1.94).
Conclusion
In patients with left main coronary artery disease, angioplasty showed similar rates of mortality and combined endpoints, but a higher rate of revascularization, at 10 years. If we only analyze the outcomes of patients who received drug-eluting stents, after 5 years, surgery outperformed angioplasty in relation to all events, including mortality.
Original title: 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease.
Reference: Duk-Woo Park et al. J Am Coll Cardiol. 2018 Dec 11;72(23 Pt A):2813-2822.
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