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 ChaeYangsoo Jang, Myung Ho Jeong, Seung Jea Tahk, Ki Bae Seung, Seung Jung Park

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191 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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ahn, J. M., Roh, J. H., Kim, Y. H., Park, D. W., Yun, S. C., Lee, P. H., Chang, M., Park, H. W., Lee, S. W., Lee, C. W., Park, S. W., Choo, S. J., Chung, C., Lee, J., Lim, D. S., Rha, S. W., Lee, S. G., Gwon, H. C., Kim, H. S., ... Park, S. J. (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, 65(20), 2198-2206. https://doi.org/10.1016/j.jacc.2015.03.033