Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients with Distal Left Main Coronary Disease

Abstract

Background and Aim: Conflicting results about coronary artery bypass grafting [CABG] versus percutaneous coronary interventions [PCI] in patients with left main coronary artery [LMCA] disease were published. Therefore, we aimed to compare CABG versus PCI for revascularization of LMCA disease and identify factors affecting the outcome.Patients and Methods: This prospective non-randomized study was conducted on 78 patients with LMCA disease presented between 2019 and 2021. The heart team assigned patients to either CABG or PCI, and each group had 38 patients. The study outcome was one year's major adverse cerebral and cardiovascular events [MACCE].Results: There were no differences in the demographics between both groups. Body mass index was higher in patients with PCI [27.79 ± 3.09 vs. 30.78 ± 5.45 Kg/m2; P= 0.005]. Diabetes mellitus was more common among CABG patients [27 [71.1%] vs 20 [52.6%]; P= 0.005]. EuroSCORE II was significantly higher in CABG patients [1.3 [0.76 – 2.85] vs. 0.81 [0.5 – 3.68]; P<0.001]. Hospital complications other than MACCE were significantly higher in patients who had CABG [13 [34.2%] vs. 5 [13.2%]; P= 0.03]. After 12 months, there were no differences in the rate of MI, stroke, revascularization, and mortality between both groups. Factors affecting MACCE were age [OR: 1.44; P=0.04], diabetes mellitus [OR: 1.82; P 0.02], prior myocardial infarction [OR: 1.89; P=0.001], ejection fraction [OR: 1.42; P= 0.01] and SYNTAX score [OR: 1.84, P= 0.02].Conclusion: PCI could be an alternative to CABG in patients with distal left main coronary artery disease with comparable periprocedural and 1-year risk.

Keywords

• leleft main coronary
• disease
• coronary artery bypass grafting
• percutaneous
• coronary revascularization