Utilization and Outcomes of Unprotected Left Main Coronary Artery Stenting and Coronary Artery Bypass Graft Surgery

Background: Limited contemporary information is available on outcomes for patients with unprotected left main coronary artery (LMCA) disease who are revascularized. Methods: We examined the relative frequency, severity of illness, and outcomes of stenting and coronary artery bypass graft (CABG) surgery for treating unprotected LMCA disease in New York between January 1, 2000 and December 31, 2004. A total of 16,336 (98.7%) patients who underwent CABG surgery and 212 (1.3%) who underwent stenting were included in this study. Results: Stent patients had higher preprocedural severity of illness (eg, they were older, more likely to be female, and had more comorbidities). A total of 135 stent patients were matched to 135 CABG patients on baseline characteristics identified by a propensity model as predictors of type of procedure received. At the end of follow-up on December 31, 2004, the respective 2-year survival rates were 94.1% and 82.0% (hazard ratio = 0.32, p = 0.005) for the 135 pairs of matched CABG and stent patients. The respective 2-year rates for freedom from subsequent revascularization were 93.7% and 62.7% (hazard ratio = 0.15, p < 0.001). In the drug-eluting stent era between October 1, 2003 and December 31, 2004, the same trends in mortality (hazard ratio = 0.73, p = 0.69) and repeat revascularization (hazard ratio = 0.10, p = 0.03) were observed among the 56 pairs of matched CABG and drug-eluting stent patients. Conclusions: Most patients with LMCA disease who needed coronary revascularization received CABG surgery; stent patients were sicker. This study found that surgery patients experienced lower risk of long-term death and repeat revascularization. However, more studies comparing these procedures are needed, especially in the drug-eluting stent era.