RESEARCH ARTICLE


Comparison of Short- and Long-Term Clinical Outcomes of Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in 121 Patients with Unprotected Left Main Coronary Artery Disease



Xiangqian Qi1, *, Xiangrong Kong1, Kui Pu2, Hongliang Cong3, Chengzhi Lu4, Qun Dang5, Guangping Li6
1 Teda International Cardiovascular Hospital, College of Cardiovascular Disease, Tianjin Medical University, Tianjin, China
2 Tianjin 254th Hospital of Chinese People’s Liberation Army, Tianjin, China
3 Tianjin Chest Hospital, Tianjin, China
4 Tianjin No. 1 Center Hospital, Tianjin, China
5 Tianjin Nankai Hospital, Tianjin, China
6 No. 2 Hospital Affiliated to Tianjin Medical University, Tianjin, China


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© 2009 Qi et al.;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Teda International Cardiovascular Hospital, College of Cardiovascular Disease, Tianjin Medical University, Tianjin, China; Tel: 86-22-65208926; Fax: 86-22-65208001; E-mail: xiangqian.qi@utoronto.ca


Abstract

Although previous studies have shown promising safety and feasibility outcomes for percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease, limited data are available for comparison of DES implantation versus coronary artery bypass grafting (CABG) for ULMCA stenosis. A total of 121 symptomatic patients with >50% angiographic stenosis in the ULMCA underwent PCI with DES (PCI group, n=60) or CABG (CABG group, n=61). Cumulative incidence of major adverse cardiac events (MACE) including death, myocardial infarction and target-vessel revascularization were evaluated at follow-up. Baseline clinical characteristics were comparable in both groups except for a lower incidence of triple-vessel coronary disease in the PCI group compared to the CABG group (32% vs. 80%, p < 0.01). Stent implantation was successful in all lesions of the PCI group. The mean follow-up period was 20±12 months in the CABG group and 17±10 months in the PCI group. The incidence of MACE in the CABG group was significantly higher than that in the PCI group (9.8% vs. 0%, p < 0.01). And the total combined rate of MACE, heart dysfunction, cerebral infarction and re-hospitalization was also higher in the CABG group compared to the PCI group (32% vs. 0%, p < 0.01). This study indicates that PCI of ULMCA lesions with DES is safe and effective, and might be superior to CABG in some selective patients. In the PCI group, no serious procedure- related complication was observed, and the short- and long-term prognosis was better than that in the CABG group.

Keywords: ULMCA disease, drug-eluting stents, CABG, short- and long-term prognosis.