• Hiroki Shiomi, Takeshi Morimoto, Mamoru Hayano, Yutaka Furukawa, Yoshihisa Nakagawa, Junichi Tazaki, Masao Imai, Kyohei Yamaji, Tomohisa Tada, Masahiro Natsuaki, Sayaka Saijo, Shunsuke Funakoshi, Kazuya Nagao, Koji Hanazawa, Natsuhiko Ehara, Kazushige Kadota, Masashi Iwabuchi, Satoshi Shizuta, Mitsuru Abe, Ryuzo Sakata, Hitoshi Okabayashi, Michiya Hanyu, Fumio Yamazaki, Mitsuomi Shimamoto, Noboru Nishiwaki, Yutaka Imoto, Tatsuhiko Komiya, Minoru Horie, Hisayoshi Fujiwara, Kazuaki Mitsudo, Masakiyo Nobuyoshi, Toru Kita, Takeshi Kimura, and CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators.
• Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
• Am. J. Cardiol. 2012 Oct 1; 110 (7): 924-32.

AbstractThe long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.Copyright © 2012 Elsevier Inc. All rights reserved.

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