TY - JOUR
T1 - Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison With Surgical Revascularization
AU - Buszman, Pawel E.
AU - Kiesz, Stefan R.
AU - Bochenek, Andrzej
AU - Peszek-Przybyla, Ewa
AU - Szkrobka, Iwona
AU - Debinski, Marcin
AU - Bialkowska, Bozena
AU - Dudek, Dariusz
AU - Gruszka, Agata
AU - Zurakowski, Aleksander
AU - Milewski, Krzysztof
AU - Wilczynski, Miroslaw
AU - Rzeszutko, Lukasz
AU - Buszman, Piotr
AU - Szymszal, Jan
AU - Martin, Jack L.
AU - Tendera, Michal
N1 - Funding Information:
This study was sponsored by the Polish Ministry of Science and Informatics (grant 4P05B00819).
PY - 2008/2/5
Y1 - 2008/2/5
N2 - 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).
AB - 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).
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U2 - 10.1016/j.jacc.2007.09.054
DO - 10.1016/j.jacc.2007.09.054
M3 - Article
C2 - 18237682
AN - SCOPUS:38549139564
VL - 51
SP - 538
EP - 545
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 5
ER -