• Eilon Ram, Ilan Goldenberg, Yigal Kassif, Amit Segev, Jacob Lavee, Michal Einhorn-Cohen, and Ehud Raanani.
• Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
• Eur J Cardiothorac Surg. 2018 Oct 1; 54 (4): 717-723.

ObjectivesLeft main coronary artery involvement in patients with multivessel coronary artery disease provides a poor prognosis. Although the main strategy for revascularization is by coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) is being used with increased frequency.MethodsThis prospective, 3-year follow-up study included 1063 consecutive patients with multivessel coronary artery disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and PCI.ResultsOf the 1063 patients, 252 (24%) had left main coronary artery disease. Of them, 27% were treated by PCI and 73% by CABG. Factors associated with referral for PCI included older age [odds ratio (OR) 1.04; P = 0.021], renal impairment (OR 3.52; P = 0.006), prior PCI (OR 2.23; P = 0.041) and lower SYNTAX score (OR 1.05; P = 0.004). Kaplan-Meier survival analysis showed that after 3 years, all-cause mortality among left main coronary artery disease patients was significantly higher among those who underwent PCI versus CABG (26.9% vs 8.7%; P < 0.001). Multivariable analysis showed that PCI was associated with a >2-fold increased hazard for mortality compared with surgical revascularization (hazard ratio 2.13, 95% confidence interval 1.05-4.31; P = 0.036).ConclusionsIn real-life practice, clinical factors and a lower SYNTAX score affect the decision to perform PCI in left main coronary artery disease patients. Our findings suggest that CABG is associated with improved long-term survival compared to PCI in patients with left main coronary artery disease after adjustment for those factors.

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