Journal : Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease

Ki Bae Seung, M.D., Duk-Woo Park, M.D., Young-Hak Kim, M.D., Seung-Whan Lee, M.D., Cheol Whan Lee, M.D., Myeong-Ki Hong, M.D., Seong-Wook Park, M.D., Sung-Cheol Yun, Ph.D., Hyeon-Cheol Gwon, M.D., Myung-Ho Jeong, M.D., Yangsoo Jang, M.D., Hyo-Soo Kim, M.D., Pum Joon Kim, M.D., In-Whan Seong, M.D., Hun Sik Park, M.D., Taehoon Ahn, M.D., In-Ho Chae, M.D., Seung-Jea Tahk, M.D., Wook-Sung Chung, M.D., and Seung-Jung Park, M.D.
ABSTRACT

Background Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease.

Methods We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent.

Results In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [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 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents.

Conclusions In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization 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@amc.seoul.kr.

Full Text of this Article

This article has been cited by other articles:

• Jones, R. H. (2008). Percutaneous Intervention vs. Coronary-Artery Bypass Grafting in Left Main Coronary Disease. NEJM 358: 1851-1853 [Full Text]
• http://content.nejm.org