• Seung-Whan Lee, Sung-Hwan Kim, Seon-Ok Kim, Seungbong Han, Young-Hak Kim, Duk-Woo Park, Soo-Jin Kang, Cheol Whan Lee, Seong-Wook Park, and Seung-Jung Park.
• Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
• Catheter Cardiovasc Interv. 2012 Aug 1; 80 (2): 206-12.

BackgroundTo date, drug-eluting stent (DES) implantation has not been compared with coronary artery bypass grafting (CABG) for ostial left main coronary artery (LMCA) lesions.MethodsOf the 263 patients in the MAIN-COMPARE registry with ostial LMCA stenosis, 123 were treated with percutaneous coronary intervention (PCI) with DES and 140 with CABG. We compared their 5-year overall survival, composite outcomes of death, Q-wave myocardial infarction (MI) or stroke, and target vessel revascularization (TVR) rates.ResultsUnadjusted analysis showed no significant differences between CABG and DES in overall survival rates (95% confidence interval (CI) for hazard ratio (HR): 0.44 to 1.77, P = 0.71), composite outcomes (death, Q-wave MI, or stroke)-free survival rates (95% CI for HR: 0.41-1.63, P = 0.56), and TVR-free survival rates (95% CI for HR: 0.79-5.03, P = 0.14). Multivariate adjusted Cox regression analysis also showed no significant between-group differences in TVR (95% CI for HR: 0.52-3.79, P = 0.49), death (95% CI for HR: 0.79-2.82, P = 0.22) and the composite of death, Q-wave MI, or stroke (95% CI for HR: 0.65-2.57, P = 0.46). These results were sustained after propensity score adjustment and propensity score matching analysis.ConclusionsDES implantation for ostial LMCA lesions showed similar 5-year outcomes of death, major adverse events, and TVR compared with CABG. Although meticulous adjustments decreased baseline difference between the two treatments, the absence of statistical significance could be attributable to the size of the study sample and hidden bias.Copyright © 2012 Wiley Periodicals, Inc.

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