Randomized trial of stents versus bypass surgery for left main coronary artery disease

5-year outcomes of the PRECOMBAT study

Jung Min Ahn, Jae Hyung Roh, Young Hak Kim, Duk Woo Park, Sung Cheol Yun, Pil Hyung Lee, Mineok Chang, Hyun Woo Park, Seung Whan Lee, Cheol Whan Lee, Seong Wook Park, Suk Jung Choo, Cheolhyun Chung, Jaewon Lee, Do-Sun Lim, Seung-Woon Rha, Sang Gon Lee, Hyeon Cheol Gwon, Hyo Soo Kim, In Ho Chae & 5 others Yangsoo Jang, Myung Ho Jeong, Seung Jea Tahk, Ki Bae Seung, Seung Jung Park

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Background In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year. Objectives This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis. Methods We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis. Results At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012). Conclusions During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)

Original languageEnglish
Pages (from-to)2198-2206
Number of pages9
JournalJournal of the American College of Cardiology
Volume65
Issue number20
DOIs
Publication statusPublished - 2015 May 26

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Stents
Coronary Artery Disease
Outcome Assessment (Health Care)
Coronary Stenosis
Sirolimus
Confidence Intervals
Cause of Death
Stroke
Myocardial Infarction
Angioplasty
Myocardial Ischemia
Ischemia
Therapeutics

Keywords

  • coronary artery bypass grafting
  • long-term outcome
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Randomized trial of stents versus bypass surgery for left main coronary artery disease : 5-year outcomes of the PRECOMBAT study. / Ahn, Jung Min; Roh, Jae Hyung; Kim, Young Hak; Park, Duk Woo; Yun, Sung Cheol; Lee, Pil Hyung; Chang, Mineok; Park, Hyun Woo; Lee, Seung Whan; Lee, Cheol Whan; Park, Seong Wook; Choo, Suk Jung; Chung, Cheolhyun; Lee, Jaewon; Lim, Do-Sun; Rha, Seung-Woon; Lee, Sang Gon; Gwon, Hyeon Cheol; Kim, Hyo Soo; Chae, In Ho; Jang, Yangsoo; Jeong, Myung Ho; Tahk, Seung Jea; Seung, Ki Bae; Park, Seung Jung.

In: Journal of the American College of Cardiology, Vol. 65, No. 20, 26.05.2015, p. 2198-2206.

Research output: Contribution to journalArticle

Ahn, JM, Roh, JH, Kim, YH, Park, DW, Yun, SC, Lee, PH, Chang, M, Park, HW, Lee, SW, Lee, CW, Park, SW, Choo, SJ, Chung, C, Lee, J, Lim, D-S, Rha, S-W, Lee, SG, Gwon, HC, Kim, HS, Chae, IH, Jang, Y, Jeong, MH, Tahk, SJ, Seung, KB & Park, SJ 2015, 'Randomized trial of stents versus bypass surgery for left main coronary artery disease: 5-year outcomes of the PRECOMBAT study', Journal of the American College of Cardiology, vol. 65, no. 20, pp. 2198-2206. https://doi.org/10.1016/j.jacc.2015.03.033
Ahn, Jung Min ; Roh, Jae Hyung ; Kim, Young Hak ; Park, Duk Woo ; Yun, Sung Cheol ; Lee, Pil Hyung ; Chang, Mineok ; Park, Hyun Woo ; Lee, Seung Whan ; Lee, Cheol Whan ; Park, Seong Wook ; Choo, Suk Jung ; Chung, Cheolhyun ; Lee, Jaewon ; Lim, Do-Sun ; Rha, Seung-Woon ; Lee, Sang Gon ; Gwon, Hyeon Cheol ; Kim, Hyo Soo ; Chae, In Ho ; Jang, Yangsoo ; Jeong, Myung Ho ; Tahk, Seung Jea ; Seung, Ki Bae ; Park, Seung Jung. / Randomized trial of stents versus bypass surgery for left main coronary artery disease : 5-year outcomes of the PRECOMBAT study. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 20. pp. 2198-2206.
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abstract = "Background In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year. Objectives This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis. Methods We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis. Results At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5{\%} and 14.3{\%}, respectively; hazard ratio [HR]: 1.27; 95{\%} confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4{\%} and 9.6{\%}; HR, 0.89; 95{\%} CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4{\%} and 5.5{\%}, respectively; HR: 2.11; 95{\%} CI: 1.16 to 3.84; p = 0.012). Conclusions During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)",
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T1 - Randomized trial of stents versus bypass surgery for left main coronary artery disease

T2 - 5-year outcomes of the PRECOMBAT study

AU - Ahn, Jung Min

AU - Roh, Jae Hyung

AU - Kim, Young Hak

AU - Park, Duk Woo

AU - Yun, Sung Cheol

AU - Lee, Pil Hyung

AU - Chang, Mineok

AU - Park, Hyun Woo

AU - Lee, Seung Whan

AU - Lee, Cheol Whan

AU - Park, Seong Wook

AU - Choo, Suk Jung

AU - Chung, Cheolhyun

AU - Lee, Jaewon

AU - Lim, Do-Sun

AU - Rha, Seung-Woon

AU - Lee, Sang Gon

AU - Gwon, Hyeon Cheol

AU - Kim, Hyo Soo

AU - Chae, In Ho

AU - Jang, Yangsoo

AU - Jeong, Myung Ho

AU - Tahk, Seung Jea

AU - Seung, Ki Bae

AU - Park, Seung Jung

PY - 2015/5/26

Y1 - 2015/5/26

N2 - Background In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year. Objectives This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis. Methods We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis. Results At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012). Conclusions During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)

AB - Background In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year. Objectives This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis. Methods We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis. Results At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012). Conclusions During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)

KW - coronary artery bypass grafting

KW - long-term outcome

KW - percutaneous coronary intervention

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U2 - 10.1016/j.jacc.2015.03.033

DO - 10.1016/j.jacc.2015.03.033

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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