Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison With Surgical Revascularization

Pawel E. Buszman, Stefan R. Kiesz, Andrzej Bochenek, Ewa Peszek-Przybyla, Iwona Szkrobka, Marcin Debinski, Bozena Bialkowska, Dariusz Dudek, Agata Gruszka, Aleksander Zurakowski, Krzysztof Milewski, Miroslaw Wilczynski, Lukasz Rzeszutko, Piotr Buszman, Jan Szymszal, Jack L. Martin, Michal Tendera

Research output: Contribution to journalArticlepeer-review

291 Scopus citations

Abstract

Objectives: The purpose of this study was to compare the early and late results of percutaneous and surgical revascularization of left main coronary artery stenosis. Background: Unprotected left main coronary artery (ULMCA) stenting is being investigated as an alternative to bypass surgery. Methods: We randomly assigned 105 patients with ULMCA stenosis to percutaneous coronary intervention (PCI; 52 patients) or coronary artery bypass grafting (CABG; 53 patients). The primary end point was the change in left ventricular ejection fraction (LVEF) 12 months after the intervention. Secondary end points included 30-day major adverse events (MAE), major adverse cardiac and cerebrovascular events (MACCE), length of hospitalization, target vessel failure (TVF), angina severity and exercise tolerance after 1 year, and total and MACCE-free survival. Results: A significant increase in LVEF at the 12-month follow-up was noted only in the PCI group (3.3 ± 6.7% after PCI vs. 0.5 ± 0.8% after CABG; p = 0.047). Patients performed equally well on stress tests, and angina status improved similarly in the 2 groups. PCI was associated with a lower 30-day risk of MAE (p < 0.006) and MACCE (p = 0.03) and shorter hospitalizations (p = 0.0007). Total and MACCE-free 1-year survival was comparable. Left main TVF was similar in the 2 groups. During the 28.0 ± 9.9-month follow-up, there were 3 deaths in the PCI group and 7 deaths in the CABG group (p = 0.08). Conclusions: Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI. (Study of Unprotected Left Main Stenting Versus Bypass Surgery [LE MANS study]; NCT00375063).

Original languageEnglish (US)
Pages (from-to)538-545
Number of pages8
JournalJournal of the American College of Cardiology
Volume51
Issue number5
DOIs
StatePublished - Feb 5 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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