PCI and medical therapy were associated with higher 1-year MACE compared to CABG in patients with LMCA disease (HR 4.82, p<0.001 for PCI vs CABG; HR 3.75, p=0.004 for medical therapy vs CABG).
Cohort (n=550)
No
Does CABG reduce 1-year MACE compared to PCI or medical therapy in patients with significant left main coronary artery disease?
In patients with significant LMCA disease referred for CABG, undergoing CABG is associated with significantly lower 1-year MACE and all-cause mortality compared to PCI or medical therapy.
Estimación del efecto: HR 4.82 (95% CI 1.95-11.88)
valor p: p=<0.001
Abstract Background Both coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) are treatment options for patients with significant Left main coronary artery disease (LMCA). However, no data is available on outcomes of these patients treated with contemporary medical therapy. Purpose This study aimed to evaluate clinical outcomes of LMCA disease patients referred for CABG who were (i) managed medically (MED), (ii) undergo PCI or (iii) CABG. Methods This was a single-centre retrospective cohort analysis from 2015-2022 at a tertiary-level teaching hospital. To adjust for differences in baseline characteristics and disease risk factors, propensity score matching (PSM) was used to match patients who received PCI and medical therapy to patients receiving CABG. The primary endpoint was 1-year Major Adverse Cardiovascular Events (MACE) which included death from cardiovascular causes, nonfatal stroke, or nonfatal myocardial infarction. The secondary endpoint was 1-year all-cause mortality. Day 0 was the time of diagnostic coronary angiography in the MED group, time of PCI in the PCI group, and time of CABG in the CABG group. Last censored time and follow-up time will be time of the occurrence of primary endpoint, death or 12 months. Kaplan-Meier estimates were used to determine the hazard ratios (HR) with Bonferroni correction. Results A total of 550 patients (mean age 65.5 ± 10.5) with LMCA disease were referred for CABG of which 121 (22%) patients ultimately received CABG, 218 (39.6%) received PCI and 211 (38.4%) patients were managed medically. The median time from referral to CABG was 16 weeks, and the time from referral to PCI was 8 weeks. After PSM, the medical therapy groups had 121 patients and PCI had 101 patients. The CABG group had a mean syntax score of 36.7, medical therapy 34.6, and PCI 27.0. Both PCI and medical therapy had higher rates of 1-year MACE when compared to CABG (HR = 4.82, 95% CI 1.95-11.88, p0.001; and HR = 3.75, 95% CI 1.51-9.29, p = 0.004, respectively), while PCI and medical therapy had comparable 1-year MACE rates (HR =1.28, 95% CI 0.70-2.33, p=0.42). PCI and medical therapy also had higher rates of 1-year all-cause mortality compared to CABG (HR = 8.86, 95% CI 2.01-39.0, p=0.004, and HR = 8.51, 95% CI 1.96-37.01, p = 0.004, respectively), while the 1-year mortality were similar between PCI and medical therapy group (HR=1.02, 95% CI 0.50-2.10, p=0.96). Conclusions For patients with significant LMCA disease referred for CABG, CABG conferred significantly lower 1-year MACE and 1-year all course mortality when compared with PCI or medical therapy, despite having more complex anatomy. For patients who did not receive CABG, PCI or medical therapy did not confer any difference in outcomes.
Lai et al. (Sat,) conducted a cohort in significant unprotected left main coronary artery disease (n=550). PCI or medical therapy vs. CABG was evaluated on 1-year Major Adverse Cardiovascular Events (MACE) including death from cardiovascular causes, nonfatal stroke, or nonfatal myocardial infarction (HR 4.82, 95% CI 1.95-11.88, p=<0.001). PCI and medical therapy were associated with higher 1-year MACE compared to CABG in patients with LMCA disease (HR 4.82, p<0.001 for PCI vs CABG; HR 3.75, p=0.004 for medical therapy vs CABG).