Real-Life Outcomes of Patients Undergoing Cabg or Pci Intervention for Coronary Disease Involving The Left Main Coronary Artery

Background:
Involvement of the left main (LM) coronary artery in patients with multi-vessel coronary artery disease (CAD) provides a poorer prognosis. While the main strategy for myocardial revascularization in these patients is by coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) is being used with increasing frequency in many centers. We aimed to explore real-life clinical outcomes of patients with LMCAD who were referred for coronary revascularization.

Methods:
This prospective study include 1063 consecutive patients with multi-vessel CAD enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and PCI. Revascularization strategy was at the discretion of the treating team. LMCAD involvement and SYNTAX score was evaluated for each patient using a core lab blinded to revascularization strategy.

Results:
From 1063 patients with multi-vessel CAD, 252 (23.7%) had LMCAD. Patients with LMCAD were older (68±11 vs. 64±11 respectively; p<0.001) but without more chronic diseases as CHF (11.1% vs. 10.1% respectively; p=0.670), prior stroke (9.1% vs. 9.2% respectively; p=0.946), diabetes mellitus (44% vs. 44.9% respectively; p=0.806) or history of MI (24.6% vs. 29.2% respectively; p=0.191), compared to those without left main CAD. During follow-up, the 30-days mortality, 1-year mortality and 2-year mortality rates were higher in patients with left main CAD compared to those without (2.9% vs. 0.7%, p=0.004; 7.4% vs. 4%, p=0.036; 11% vs. 5.1%, p=0.001; respectively). Kaplan-Meier survival analysis showed that among patients with LMCAD mortality rates at 2 years of follow-up were significantly higher among those who underwent PCI as compared with CABG (Figure: left panel), whereas among patients without LMCAD mortality rates were similar between the two intervention groups (Figure: right panel). These results were consistent after multivariate adjustment.

Conclusion:
In real life practice CABG provides better 2-year outcomes compared to PCI in patients with LMCAD.