Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis - A single-center experience

Background - Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. Methods and Results - Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n = 107) or coronary artery bypass grafting (CABG) (n = 142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR = 0.291; 95% CI = 0.054 to 1.085; P = 0.0710) and adjusted analyses (OR = 0.331; 95% CI = 0.055 to 1.404; P = 0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR = 0.235; 95% CI = 0.048 to 0.580; P = 0.0002; adjusted OR = 0.260; 95% CI = 0.078 to 0.597; P = 0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR = 0.300; 95% CI = 0.102 to 0.617; P = 0.0004; adjusted OR = 0.385; 95% CI = 0.180 to 0.819; P = 0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR = 0.675; 95% CI = 0.371 to 1.189; P = 0.1891) and adjusted analyses (OR = 0.568; 95% CI = 0.229 to 1.344; P = 0.2266). Conclusions - At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.