Percutaneous coronary intervention versus coronary artery bypass grafting for unprotected left main true bifurcation lesions

Background: There are few studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of bifurcation lesions of unprotected left main coronary artery (ULMCA). In the present study, we compared 1-year clinical outcomes of PCI with drug-eluting stent (DES) versus CABG in patients with ULMCA true bifurcation lesions. Methods: We evaluated a total of 276 consecutive patients with ULMCA true bifurcation lesions who underwent PCI with DES (n = 208) or CABG (n = 68). Propensity score (PS) adjustment and matching were applied to balance the baseline differences between groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Results: At 1 year, the incidence rate of MACCE was no significant difference between the PCI and CABG groups (12.5% vs. 19.1%, P = 0.163; PS-adjusted hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.37-1.63; P = 0.498); the rates of death (2.4% vs. 8.8%, P = 0.018) and the composite of death, myocardial infarction or stroke (7.7% vs. 17.6%, P = 0.019) were observed less frequently in the PCI group, which were no longer significantly different after PS adjustment (for death, PS-adjusted HR: 0.41, 95% CI: 0.11-1.61, P = 0.203; for the composite of death, myocardial infarction or stroke, PS-adjusted HR: 0.59, 95% CI: 0.25-1.37, P = 0.219). Conclusions: For the treatment of ULMCA true bifurcation lesions, PCI with DES was associated with similar 1-year clinical outcomes when compared with CABG.