Historical data suggest that patients with multi-vessel coronary disease involving the left main stem or proximal left anterior descending artery may gain prognostic benefit from coronary artery bypass grafting (CABG). Whether percutaneous coronary intervention (PCI) achieves similar outcomes remains unclear.Methods
We performed a retrospective linkage study to determine outcomes in all patients undergoing coronary revascularisation for multi-vessel disease involving the left main stem or proximal left anterior descending coronary artery at the Royal Infirmary of Edinburgh over a 12-month period (2009–2010). The primary endpoint was a composite of death, myocardial infarction, stroke or readmission with heart failure at 12 months.Results
Of 303 patients, 168 (55%) underwent CABG and 135 (45%) PCI. Patients undergoing PCI were older (68 ± 12 yrs vs 65 ± 10 yrs, p < 0.05), had less left main disease (30(22%) vs 75(45%), p < 0.001) and a greater updated Euroscore II (2.3 ± 2.3 vs 1.2 ± 1.1, p < 0.05), but similar Syntax scores (27 ± 12 vs 27 ± 10, p = ns) compared to patients undergoing CABG. Patients undergoing PCI received 2.4 ± 1.1 stents (65% drug-eluting) to treat 2.3 ± 0.8 vessels. Patients undergoing CABG received 2.1 ± 0.6 grafts (97% received an internal mammary graft). At 12 month follow-up, there was no difference in the primary endpoint, but mortality was lower in the PCI group (1(1%) vs 8(5%), p < 0.05). Following multivariate regression analysis, the presence of left main stem disease and a greater Euroscore II, but not mode of revascularisation, were predictive of the primary endpoint.Conclusions
In this study of real-world practice, our findings suggest that PCI may be an acceptable alternative strategy to CABG in selected patients with high-risk coronary anatomy.