Comparison of percutaneous coronary intervention versus coronary artery bypass graft in aged patients with unprotected left main artery lesions

Abstract

There is still much debate about revascularization strategies in aged patients with unprotected left main coronary artery (UPLM) lesions. This study compared the outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in this population. A total of 126 patients older than 60 years of age with LM lesions who underwent revascularization in our hospital from January 2012 to December 2013 were followed up for an average of 15.2 months. The cumulative incidence of major adverse cardiac and cerebral events (MACCE) was estimated by Kaplan-Meier plots. During follow-up, the CABG group had higher proportions of cardiac death, stroke, and worsening of heart failure while the PCI group had a higher proportion of recurrence of angina (P = 0.04). The MACCE incidence was lower in the PCI group than that in the CABG group (28.9% versus 35.6%, P = 0.04). Multivariate regression identified left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) as predictors of PCI, while age, LVEF, EuroScore, and diabetes were the predictors of CABG. PCI maintained its superiority over CABG after adjustment for risk factors (Hazard ratio: 0.28, P = 0.004). The CABG group included a higher proportion of severe hemorrhagic complications than the PCI group (P = 0.04). In terms of efficacy and safety, PCI had an advantage over CABG in aged patients with UPLM lesions. Thus, PCI was a reasonable alternative to CABG for this population.