Comparative analysis of conservative, percutaneous, and surgical treatment outcomes in patients with significant stenosis of the left main coronary artery during five-year follow-up.

BACKGROUND AND AIM

Significant left main coronary artery stenosis (LMS) conveys adverse prognosis and until recently its treatment has been restricted to surgical intervention. We evaluated the long term outcome of patients with LMS treated using different approaches i.e. medical treatment, surgical (CABG, coronary artery bypass graft) and percutaneous (PCI, percutaneous coronary intervention).

METHODS

We analysed 450 patients with significant LMS (%DS > 50%). Group 1 (G1) included 105 patients who did not qualify for invasive treatment. Group 2 (G2) included 282 patients who underwent CABG. Group 3 (G3) comprised 67 patients who received stent into LMS. We analysed the incidence of invasive treatment complications in G2 and G3 and the overall incidence of adverse cardiac events that comprised death, repeated myocardial infarction, and the necessity of repeated revascularisation during hospital stay and long term follow-up.

RESULTS

During the 5-year follow-up, the highest mortality was noted in the G1 in comparison to G2 and G3 (31.3% vs 24.5% vs 26.8% respectively). There was no difference in mortality between G2 and G3. The incidence of myocardial infarction was the lowest in G3 (22.2%) followed by G1 (40.8%) and G2 (45.1%). No difference was detected in the occurrence of repeated PCI in LMS (G2 - 19.85%, G3 - 13.4%) and CABG (G1 - 12.2%, G2 - 10.2%, G3 - 9.0%). The incidence of target vessel revascularisation was the highest in G1, followed by G2 and G3 (69.49% vs 53.19% vs 31.35% respectively).

CONCLUSIONS

Our study showed that CABG and PCI provide similar long-term outcome in patients with LMS.