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Long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting for unprotected left main coronary bifurcation disease in the drug-eluting stent era
  1. Kiyuk Chang1,2,
  2. Yoon-Seok Koh1,3,
  3. Seung Hee Jeong4,5,
  4. Jong-Min Lee1,3,
  5. Sung-Ho Her1,6,
  6. Hun-Jun Park1,2,
  7. Pum-Joon Kim1,2,
  8. Young-Hak Kim7,
  9. Wook-Sung Chung1,2,
  10. Hyeon-Woo Yim4,5,
  11. Seung-Jung Park7,
  12. Ki Bae Seung1,2
  1. 1Department of Cardiovascular Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  2. 2Cardiovascular Center, Seoul St Mary's Hospital, Seoul, Republic of Korea
  3. 3Cardiovascular Center, Uijeongbu St Mary's Hospital, Uijeongbu, Republic of Korea
  4. 4Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  5. 5Clinical Research Coordinating Center of Catholic Medical Center, Seoul, Republic of Korea
  6. 6Cardiovascular Center, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
  7. 7Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Professor Ki Bae Seung, Cardiovascular Center and Cardiology Division, Seoul St Mary's Hospital, 505 Banpodong, Seochogu, Seoul 137-701, Republic of Korea; kbseung{at}


Objectives There are limited data on long-term outcomes (ie, beyond 4 years) for patients with unprotected left main bifurcation disease who underwent percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the drug-eluting stent (DES) era. This study therefore compared the treatment effects of PCI and CABG in unprotected left main bifurcation disease.

Methods 865 patients with unprotected left main bifurcation disease treated with either PCI using DES (n=556) or CABG (n=309) were evaluated between May 2003 and December 2009. PCI-treated patients were further categorised into simple stenting (n=360) or complex stenting (n=196).

Results Median follow-up was 4.2 years (IQR 2.9–5.2 years). After adjusting covariates with multivariate Cox hazard regression model and inverse probability of treatment weighting, the long-term cumulative rates of death (HR 0.95; 95% CI 0.62 to 1.45) or composite of death, Q-wave myocardial infarction, or stroke (HR 0.97, 95% CI 0.64 to 1.48) were not significantly different for patients undergoing PCI or CABG except for target-vessel revascularisation (TVR) (HR 4.42, 95% CI 2.39 to 8.18). The complex stenting group had similar long-term clinical outcomes compared with the simple stenting group except for TVR (HR 1.94, 95% CI 1.22 to 3.10). In further analysis with propensity score matching, overall findings were consistent.

Conclusions In patients with unprotected left main bifurcation disease, PCI using DES provides similar long-term (up to 5.2 years) clinical outcomes except for TVR compared with CABG. Complex and simple stenting yielded similar outcomes except for a higher TVR rate in complex stenting.

  • Atherosclerosis
  • chest pain clinic
  • coronary artery disease
  • coronary artery bypass grafting
  • coronary intervention (PCI)
  • coronary stenting
  • fractional flow reserve
  • hypertension
  • inflammation
  • interventional cardiology
  • intravascular ultrasound
  • left main bifurcation disease
  • percutaneous coronary intervention
  • platelets
  • radionuclide imaging
  • spasm

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the institutional review board at each hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.