Comparison Of Drug Eluting Stents Versus Coronary Artery Bypass Grafting For End Disease That Involve Unprotected Left Main Coronary Artery

Objectives:The patients with unprotected left main coronary artery (ULMCA) and end disease are the high-risk group of coronary atherosclerotic heart disease (CHD). Although it is thought that the preferred treatment for this condition is coronary artery bypass grafting (CABG), most patients are treated with percutaneous coronary intervention (PCI) because of the long-recovery time and great traumatic of CABG. There are limited data regarding the long-term outcomes of these two interventions for patients with ULMCA and end.Method:We reviewed outcomes among 106 consecutive patients with ULMCA and end disease who underwent PCI or CAGB in Beijing AnZhen Hospital between January 2005 and December 2008. All-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), and the combined majoradverse clinical event (MACE) rates at one year were computed. We also used the EuroSCORE and SYNTAX SCORE to assess the association between disease risks and clinical events.Result:1. There was no significant difference between the PCI-DES and CABG groups in baseline characteristics (gender, age, smoking, blood lipids, hypertension, diabetes, left ventricular ejection fraction, chronic obstructive pulmonary disease, medication, and follow-up time).2.There were also no significant difference in all-cause mortality, non-fatal MI, TVR and MACE rates between the two groups (P>0.05).3. EuroSCORE and SYNTAX SCORE were higher in CAGB group than PCI group (P=0.038, P=0.004)4. There were no significant difference in MACE (P=0.977), event free survival (P=0.899) and target vessel revascularization-free survival (P=0.942) between the two groups.5. Patients in the two groups were divided into high-risk group (≥5) and low-risk group (≤5) by using EuroSCORE. Compared with low-risk group, MACE was increased in the high-risk group of CABG and EFS was decreased (P=0.003, P=0.002). For the patients underwent PCI, there were no significant difference between low-risk group and high-risk group in MACE and EFS (P=0.974, P=0.082). In the high-risk group, MACE was higher in patients underwent CABG than PCI but it was no significant difference (P=0.826) and EFS was similar in all patients (P=0.720). In the low-risk group, MACE and EFS were also similar between the patients underwent PCI and CABG (P=0.412, P=0.325).6. Patients were divided into high-risk group (≥27) and low-risk group (≤27) by using SYNTAX SCORE system. Compared with low-risk group, MACE was increased in the high-risk group of the patients underwent PCI and EFS was decreased significantly (P=0.004, P=0.037). But there were no significant difference in MACE and FES between low-risk group and high-risk group of the patients underwent CABG (P=0.736, P=0.233). In the high-risk group, MACE was higher and EFS was lower in patients underwent PCI than CABG but it was no significant difference (P=0.305, P=0.220). In the low-risk group, MACE was higher in patients underwent CABG than PCI but it was no significant difference (P=0.536).7. In the high-tisk patients with EuroSCORE≥5.0 and SYNTAX SCORE≥27.0, EFS was higher in CABG than PCI group but it was no significant difference.8. EuroSCORE≥5.0 is the independent risk factor of the outcomes of CABG (P=0.027). SYNTAX SCORE≥27.0 is the independent risk factor of the outcomes of PCI (P=0.020).Conclusion:For the ULMCA and end disease patients with EuroSCORE≥5.0, the preferred treatment should be PCI. However, the outcomes of CABG is better than PCI when the SYNTAX SCORE≥27.0. EuroSCORE≥5.0 is the independent risk factor of the outcomes of CABG and SYNTAX SCORE≥27.0 is the independent risk factor of the outcomes of PCI. Although PCI is feasible and effective for patients with ULMCA and end, the treatment should be chosen by according to the conditions of patients.