Mid-Term Results and Costs of Coronary Artery Bypass vs Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease

Tsuyoshi Shimizu, Takayuki Ohno, Jiro Ando, Hideo Fujita, Ryozo Nagai, Noboru Motomura, Minoru Ono, Shunei Kyo, Shinichi Takamoto
2010 Circulation Journal  
The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Methods and Results : Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute
more » ... CE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2±1.1 years in the CABG group and 1.6±0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen). Conclusions: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease. (Circ J 2010; 74: 449 - 455)
doi:10.1253/circj.cj-09-0586 pmid:20075560 fatcat:idlit2oyzrdsnlv3pao3usd5ze