Background Several studies have compared the treatment effectsof coronary stenting and coronary-artery bypass grafting (CABG).However, there are limited data regarding the long-term outcomesof these two interventions for patients with unprotected leftmain coronary artery disease.
Methods We evaluated 1102 patients with unprotected left maincoronary artery disease who underwent stent implantation and1138 patients who underwent CABG in Korea between January 2000and June 2006. We compared adverse outcomes (death; a compositeoutcome of death, Q-wave myocardial infarction, or stroke; andtarget-vessel revascularization) with the use of propensity-scorematching in the overall cohort and in separate subgroups accordingto type of stent.
Results In the overall matched cohort, there was no significantdifference between the stenting and CABG groups in the riskof death (hazard ratio for the stenting group, 1.18; 95% confidenceinterval [CI], 0.77 to 1.80) or the risk of the composite outcome(hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to1.62). The rates of target-vessel revascularization were significantlyhigher in the group that received stents than in the group thatunderwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisonsof the group that received bare-metal stents with the groupthat underwent CABG and of the group that received drug-elutingstents with the group that underwent CABG produced similar results,although there was a trend toward higher rates of death andthe composite end point in the group that received drug-elutingstents.
Conclusions In a cohort of patients with unprotected left maincoronary artery disease, we found no significant differencein rates of death or of the composite end point of death, Q-wavemyocardial infarction, or stroke between patients receivingstents and those undergoing CABG. However, stenting, even withdrug-eluting stents, was associated with higher rates of target-vesselrevascularization than was CABG.
Source Information
From the Catholic University of Korea, St. Mary's Hospital, Gangnam (K.B.S., P.J.K.) and Yeoido (W.-S.C.), Seoul; the Department of Cardiology (D.-W.P., Y.-H.K., S.-W.L., C.W.L., M.-K.H., S.-W.P., S.-J.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul; Samsung Medical Center, Seoul (H.-C.G.); Chonnam National University Hospital, Gwangju (M.-H.J.); Yonsei University Severance Hospital, Seoul (Y.J.); Seoul National University Hospital, Seoul (H.-S.K.) and Bundang (I.-H.C.); Chungnam National University Hospital, Daejeon (I.-W.S.); Kyung Pook National University Hospital, Daegu (H.S.P.); Gachon University Gil Medical Center, Incheon (T.A.); and Ajou University Medical Center, Suwon (S.-J.T.) — all in Korea. Drs. K.B. Seung and D.-W. Park contributed equally to this article. This article (10.1056/NEJMoa0801441) was published at www.nejm.org on March 31, 2008.
Address reprint requests to Dr. Seung-Jung Park at the Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea, or at sjpark{at}amc.seoul.kr.
Park, D.-W., Yun, S.-C., Lee, J.-Y., Kim, W.-J., Kang, S.-J., Lee, S.-W., Kim, Y.-H., Lee, C. W., Kim, J.-J., Park, S.-W., Park, S.-J.
(2009). C-Reactive Protein and the Risk of Stent Thrombosis and Cardiovascular Events After Drug-Eluting Stent Implantation. Circulation
120: 1987-1995
[Abstract][Full Text]
Toyofuku, M., Kimura, T., Morimoto, T., Hayashi, Y., Ueda, H., Kawai, K., Nozaki, Y., Hiramatsu, S., Miura, A., Yokoi, Y., Toyoshima, S., Nakashima, H., Haze, K., Tanaka, M., Take, S., Saito, S., Isshiki, T., Mitsudo, K., on Behalf of the j-Cypher Registry Investigators,
(2009). Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease: Insights From the j-Cypher Registry. Circulation
120: 1866-1874
[Abstract][Full Text]
Bastarrika, G., Lee, Y. S., Huda, W., Ruzsics, B., Costello, P., Schoepf, U. J.
(2009). CT of Coronary Artery Disease. Radiology
253: 317-338
[Abstract][Full Text]
Kandzari, D. E., Colombo, A., Park, S.-J., Tommaso, C. L., Ellis, S. G., Guzman, L. A., Teirstein, P. S., Tamburino, C., Ormiston, J., Stone, G. W., Dangas, G. D., Popma, J. J., Bass, T. A., on behalf of the American College of Cardiology In,
(2009). Revascularization for unprotected left main disease: evolution of the evidence basis to redefine treatment standards.. J Am Coll Cardiol
54: 1576-1588
[Abstract][Full Text]
Buszman, P. E., Buszman, P. P., Kiesz, R. S., Bochenek, A., Trela, B., Konkolewska, M., Wallace-Bradley, D., Wilczynski, M., Banasiewicz-Szkrobka, I., Peszek-Przybyla, E., Krol, M., Kondys, M., Milewski, K., Wiernek, S., Debinski, M., Zurakowski, A., Martin, J. L., Tendera, M.
(2009). Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting: The LE MANS (Left Main Coronary Artery Stenting) Registry. J Am Coll Cardiol
54: 1500-1511
[Abstract][Full Text]
Moses, J. W., Leon, M. B., Stone, G. W.
(2009). Left Main Percutaneous Coronary Intervention Crossing the Threshold: Time for a Guidelines Revision!. J Am Coll Cardiol
54: 1512-1514
[Full Text]
Akhtar, R. P., Naqshband, M. S., Abid, A. R., Tufail, Z., Waheed, A., Khan, J. S.
(2009). Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience. Asian Cardiovasc. Thorac. Ann.
17: 472-476
[Abstract][Full Text]
Gulati, R., Rihal, C. S., Gersh, B. J.
(2009). The SYNTAX Trial: A Perspective. Circ Cardiovasc Interv
2: 463-467
[Full Text]
Montalescot, G., Brieger, D., Eagle, K. A., Anderson, F. A. Jr, FitzGerald, G., Lee, M. S., Steg, Ph. G., Avezum, A., Goodman, S. G., Gore, J. M., for the GRACE Investigators,
(2009). Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J
30: 2308-2317
[Abstract][Full Text]
Kim, W.-J., Park, D.-W., Yun, S.-C., Lee, J.-Y., Lee, S.-W., Kim, Y.-H., Lee, C. W., Park, S.-W., Park, S.-J.
(2009). Impact of Diabetes Mellitus on the Treatment Effect of Percutaneous or Surgical Revascularization for Patients With Unprotected Left Main Coronary Artery Disease: A Subgroup Analysis of the MAIN-COMPARE Study. J Am Coll Cardiol Intv
2: 956-963
[Abstract][Full Text]
Williams, D. O., Abbott, J. D.
(2009). Diabetes Mellitus Does Not Unsweeten Left Main Intervention. J Am Coll Cardiol Intv
2: 964-966
[Full Text]
Sheiban, I., Sillano, D., Biondi-Zoccai, G., Chieffo, A., Colombo, A., Vecchio, S., Margheri, M., Gunn, J. P., Raina, T., Liistro, F., Bolognese, L., Lee, M. S., Tobis, J., Moretti, C.
(2009). Incidence and management of restenosis after treatment of unprotected left main disease with drug-eluting stents 70 restenotic cases from a cohort of 718 patients: FAILS (Failure in Left Main Study).. J Am Coll Cardiol
54: 1131-1136
[Abstract][Full Text]
Palmerini, T., Sangiorgi, D., Marzocchi, A., Tamburino, C., Sheiban, I., Margheri, M., Vecchi, G., Sangiorgi, G., Ruffini, M., Bartorelli, A. L., Briguori, C., Vignali, L., Di Pede, F., Ramondo, A., Inglese, L., De Carlo, M., Bolognese, L., Benassi, A., Palmieri, C., Filippone, V., Barlocco, F., Lauria, G., De Servi, S.
(2009). Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology. Eur Heart J
30: 2087-2094
[Abstract][Full Text]
Lee, J. Y., Park, D.-W., Yun, S.-C., Lee, S.-W., Kim, Y.-H., Lee, C. W., Hong, M.-K., Park, S.-W., Park, S.-J.
(2009). Long-Term Clinical Outcomes of Sirolimus- Versus Paclitaxel-Eluting Stents for Patients With Unprotected Left Main Coronary Artery Disease Analysis of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry.. J Am Coll Cardiol
54: 853-859
[Abstract][Full Text]
Kim, Y.-H., Park, D.-W., Lee, S.-W., Yun, S.-C., Lee, C. W., Hong, M.-K., Park, S.-W., Seung, K. B., Gwon, H.-C., Jeong, M.-H., Jang, Y., Kim, H.-S., Seong, I.-W., Park, H. S., Ahn, T., Chae, I.-H., Tahk, S.-J., Chung, W.-S., Park, S.-J., for the Revascularization for Unprotected Left Mai,
(2009). Long-Term Safety and Effectiveness of Unprotected Left Main Coronary Stenting With Drug-Eluting Stents Compared With Bare-Metal Stents. Circulation
120: 400-407
[Abstract][Full Text]
Naik, H., White, A. J., Chakravarty, T., Forrester, J., Fontana, G., Kar, S., Shah, P. K., Weiss, R. E., Makkar, R.
(2009). A Meta-Analysis of 3,773 Patients Treated With Percutaneous Coronary Intervention or Surgery for Unprotected Left Main Coronary Artery Stenosis. J Am Coll Cardiol Intv
2: 739-747
[Abstract][Full Text]
Adams, D. H., Anyanwu, A. C., Chikwe, J., Filsoufi, F.
(2009). The Year in Cardiovascular Surgery. J Am Coll Cardiol
53: 2389-2403
[Full Text]
Dixon, S. R., Grines, C. L., O'Neill, W. W.
(2009). The year in interventional cardiology.. J Am Coll Cardiol
53: 2080-2097
[Full Text]
Stone, G. W., Mintz, G. S.
(2009). Unprotected Left Main Intervention: The Light at the End of the Tunnel?. Circ Cardiovasc Interv
2: 156-158
[Full Text]
Park, S.-J., Kim, Y.-H., Park, D.-W., Lee, S.-W., Kim, W.-J., Suh, J., Yun, S.-C., Lee, C. W., Hong, M.-K., Lee, J.-H., Park, S.-W., for the MAIN-COMPARE Investigators,
(2009). Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis. Circ Cardiovasc Interv
2: 167-177
[Abstract][Full Text]
Alfonso, F.
(2009). Left main coronary artery stenting crossing the rubicon.. J Am Coll Cardiol
53: 1769-1772
[Full Text]
Mehilli, J., Kastrati, A., Byrne, R. A., Bruskina, O., Iijima, R., Schulz, S., Pache, J., Seyfarth, M., Massberg, S., Laugwitz, K.-L., Dirschinger, J., Schomig, A., for the ISAR-LEFT-MAIN (Intracoronary Stenting and,
(2009). Paclitaxel- Versus Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease. J Am Coll Cardiol
53: 1760-1768
[Abstract][Full Text]
Vaquerizo, B., Lefevre, T., Darremont, O., Silvestri, M., Louvard, Y., Leymarie, J. L., Garot, P., Routledge, H., de Marco, F., Unterseeh, T., Zwahlen, M., Morice, M.-C.
(2009). Unprotected Left Main Stenting in the Real World: Two-Year Outcomes of the French Left Main Taxus Registry. Circulation
119: 2349-2356
[Abstract][Full Text]
Tamburino, C., Di Salvo, M. E., Capodanno, D., Marzocchi, A., Sheiban, I., Margheri, M., Maresta, A., Barlocco, F., Sangiorgi, G., Piovaccari, G., Bartorelli, A., Briguori, C., Ardissino, D., Di Pede, F., Ramondo, A., Inglese, L., Petronio, A. S., Bolognese, L., Benassi, A., Palmieri, C., Patti, A., De Servi, S.
(2009). Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry. Eur Heart J
30: 1171-1179
[Abstract][Full Text]
Takagi, H., Manabe, H., Kawai, N., Goto, S.-n., Umemoto, T.
(2009). Unprotected left main coronary artery stenting versus coronary artery bypass graft surgery.. Ann. Thorac. Surg.
87: 1651-1652
[Full Text]
Palmerini, T., Marzocchi, A., Tamburino, C., Sheiban, I., Margheri, M., Vecchi, G., Sangiorgi, G., Santarelli, A., Bartorelli, A. L., Briguori, C., Vignali, L., Di Pede, F., Ramondo, A., Inglese, L., De Carlo, M., Bolognese, L., Benassi, A., Palmieri, C., Filippone, V., Sangiorgi, D., Barlocco, F., Lauria, G., De Servi, S.
(2009). Temporal pattern of ischemic events in relation to dual antiplatelet therapy in patients with unprotected left main coronary artery stenosis undergoing percutaneous coronary intervention.. J Am Coll Cardiol
53: 1176-1181
[Abstract][Full Text]
Lange, R. A., Hillis, L. D.
(2009). Coronary Revascularization in Context. NEJM
360: 1024-1026
[Full Text]
Smith, C. R.
(2009). Surgery, Not Percutaneous Revascularization, Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis. Circulation
119: 1013-1020
[Full Text]
Teirstein, P. S.
(2009). Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis. Circulation
119: 1021-1033
[Full Text]
Park, S.-J., Park, D.-W.
(2009). Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease: Is It Time to Change Guidelines?. Circ Cardiovasc Interv
2: 59-68
[Abstract][Full Text]
Takagi, H., Kawai, N., Umemoto, T.
(2009). Stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: a meta-analysis of comparative studies.. J. Thorac. Cardiovasc. Surg.
137: e54-e57
[Full Text]
Park, S.-J., Kim, Y.-H.
(2008). Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia. Circulation
118: 2730-2737
[Full Text]
Price, M. J., Kandzari, D. E., Teirstein, P. S.
(2008). Change We Can Believe In: The Hyper-Evolution of Percutaneous Coronary Intervention for Unprotected Left Main Disease With Drug-Eluting Stents. Circ Cardiovasc Interv
1: 164-166
[Full Text]
Palmerini, T., Marzocchi, A., Tamburino, C., Sheiban, I., Margheri, M., Vecchi, G., Sangiorgi, G., Santarelli, A., Bartorelli, A., Briguori, C., Vignali, L., Di Pede, F., Ramondo, A., Inglese, L., De Carlo, M., Falsini, G., Benassi, A., Palmieri, C., Filippone, V., Sangiorgi, D., Barlocco, F., De Servi, S.
(2008). Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents. Circ Cardiovasc Interv
1: 185-192
[Abstract][Full Text]
Rademacher, W., Knape, A., Schumm, J., Ferrari, M., Lauten, A., Mudra, H., Figulla, H. R.
(2008). Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk. ICVTS
7: 871-877
[Abstract][Full Text]
Kaul, S., Boden, W. E., Ferguson, T. B. Jr, Guyton, R. A., Mack, M. J., Sergeant, P. T., Shemin, R. J., Smith, P. K., Yusuf, S., Taggart, D. P.
(2008). Reply. J Am Coll Cardiol
52: 584-586
[Full Text]
Holmes, D. R. Jr, Williams, D. O.
(2008). Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future. Circ Cardiovasc Interv
1: 60-73
[Abstract][Full Text]
Pocar, M., Donatelli, F., Moneta, A., Tomoda, H., Tayek, J. A., Arnold, J. R., Banning, A. P., Park, S.-J., Park, D.-W., Kim, Y.-H.
(2008). Stents versus Bypass Grafting for Left Main Coronary Artery Disease. NEJM
359: 423-425
[Full Text]
(2008). Stenting for Left Main Coronary Artery Disease?. JWatch General
2008: 2-2
[Full Text]
(2008). All you need to read in the other general journals. BMJ
336: 984-985
[Full Text]
Jones, R. H.
(2008). Percutaneous Intervention vs. Coronary-Artery Bypass Grafting in Left Main Coronary Disease. NEJM
358: 1851-1853
[Full Text]
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