Comparison of Long-Term Outcome After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery Disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Abstract

The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.

Comparison of Five-Year Outcome of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Triple-Vessel Coronary Artery Disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2)

“…6,7 The relevant ethics committees in all 26 participating centers (Supplementary data A) approved the research protocol. Because of retrospective enrollment, written informed consents from the patients were waived; however, we excluded those patients who refused participation in the study when contacted for follow-up.…”

Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease – 5-Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort-2 –

“…5-7,13, 16 Therefore, in ULMCAD patients with relatively less anatomical complexity, represented by a low or intermediate SYNTAX score, PCI using DES is a reasonable alternative to CABG in real-world clinical practice. On the other hand, CABG still remains the preferable treatment for ULMCAD patients with high anatomical complexity (ie, high SYNTAX score or complex multivessel disease), because the clinical outcome after CABG is not affected by anatomical complexity.…”

“…12- 15 We previously reported 3-year outcome in patients with ULMCAD from the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry cohort-2, demonstrating that (1) 3-year clinical outcome of PCI was comparable with that of CABG in terms of serious cardiovascular events in patients with ULMCAD and (2) the risk for serious cardiovascular events was not significantly different between PCI and CABG in patients with low or intermediate SYNTAX score, but was markedly higher after PCI as compared with CABG in patients with high SYNTAX score. 16 In the current report, we extended the follow-up to evaluate longer-term (≥5 years) outcome of PCI compared with CABG in patients with ULMCAD in real-world clinical practice.…”

Long‐term prognostic value of risk scores after drug‐eluting stent implantation for unprotected left main coronary artery: A pooled analysis of the ISAR‐LEFT‐MAIN and ISAR‐LEFT‐MAIN 2 randomized clinical trials

“…The most powerful data confirming the ability of the SxScore to predict differential clinical outcomes of patients with uLMCA disease undergoing percutaneous or surgical revascularization according to its different tertiles, come from the SYNTAX trial itself . An analysis by the CREDO/Kyoto PCI/CABG Registry Cohort‐2 provided confirmatory evidence to these results . Furthermore, Capodanno et al showed that patients with uLMCA disease and SxScore > 34 derive a mortality benefit from surgical revascularization compared with a PCI strategy.…”