Mid-Term Results and Costs of Coronary Artery Bypass vs Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease

作者：Shimizu Tsuyoshi^*; Ohno Takayuki; Ando Jiro; Fujita Hideo; Nagai Ryozo; Motomura Noboru; Ono Minoru; Kyo Shunei; Takamoto Shinichi

来源：Circulation Journal, 2010, 74(3): 449-455.

DOI：10.1253/circj.CJ-09-0586

• Coronary artery bypass
• Coronary artery disease
• Drug-eluting stents
• Percutaneous coronary intervention

Background: The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
Methods and Results: Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2 +/- 1.1 years in the CABG group and 1.6 +/- 0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen).
Conclusions: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease. (Circ J 2010; 74: 449-455)

• 出版日期2010-3