Skip to main content
SpringerLink
Log in

Early and long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention in patients with left main disease: single-center results of multidisciplinary decision making

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Coronary artery bypass grafting (CABG) is considered the standard treatment for patients with left main disease (LMD). However, percutaneous coronary intervention (PCI) has recently emerged as a treatment option for selected patients. We assessed early and long-term outcomes of patients with LMD who underwent either CABG or PCI in our institution.

Methods

We reviewed the records of 438 patients with LMD who underwent revascularization between January 2005 and December 2010. Treatment modality, chosen by our heart team, was CABG in 409 patients and PCI in 29. Age, prevalence of women, and mean ejection fraction of patients were not significantly different between groups. Mean logistic European system for cardiac operative risk evaluation score was 7.7. Mean follow-up was 37.1 months.

Results

In CABG group, mean number of anastomoses was 4.0 and complete revascularization was achieved in 97.1 %. Bilateral internal thoracic arteries were used in 87.0 %. In PCI group, mean number of stents was 1.3 and complete revascularization was achieved in 44.8 %. Drug-eluting stent was used in 72.4 %. In-hospital mortality was 1.1 % (1.0 %, CABG group vs. 3.4 %, PCI group; p = 0.29). At 3 years, overall survival was 94.3 % (95.3 vs. 81.1 %; p < 0.01) and rate of freedom from major adverse cardiac events and cerebrovascular accidents was 88.9 % (89.8 vs. 77.3 %; p = 0.05).

Conclusions

Our heart team’s approach resulted in favorable overall results in patients with LMD. Multidisciplinary decision making in these high-risk patients can make good long-term outcomes in CABG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2011;124:2610–42.

    Article  PubMed  Google Scholar 

  2. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Task force on myocardial revascularization of the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS); European association for percutaneous cardiovascular interventions (EAPCI), Guidelines on myocardial revascularization. Eur Heart J. 2010; 31:2501–55.

    Google Scholar 

  3. Montalescot G, Brieger D, Eagle KA, Anderson FA Jr, FitzGerald G, Lee MS, et al., GRACE Investigators. Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J 2009; 30:2308–17.

    Google Scholar 

  4. Valgimigli M, Malagutti P, Rodriguez-Granillo GA, Garcia–Garcia HM, Polad J, Tsuchida K, et al. Distal left main coronary disease is a major predictor of outcome in patients undergoing percutaneous intervention in the drug-eluting stent era: an integrated clinical and angiographic analysis based on the Rapamycin-eluting stent evaluated at Rotterdam cardiology hospital (RESEARCH) and Taxus-Stent evaluated at Rotterdam cardiology hospital (T-SEARCH) registries. J Am Coll Cardiol. 2006;47:1530–7.

    Article  PubMed  Google Scholar 

  5. Caggegi A, Capodanno D, Capranzano P, Chisari A, Ministeri M, Mangiameli A, et al. Comparison of one-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease and acute coronary syndromes (from the CUSTOMIZE Registry). Am J Cardiol. 2011;108:355–9.

    Article  PubMed  Google Scholar 

  6. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629–38.

    Article  PubMed  Google Scholar 

  7. Fukui T, Takanashi S, Hosoda Y, Suehiro S. Early and midterm results of off-pump coronary artery bypass grafting. Ann Thorac Surg. 2007;83:115–9.

    Article  PubMed  Google Scholar 

  8. Fukui T, Takanashi S, Hosoda Y. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg. 2005;80:2098–105.

    Article  PubMed  Google Scholar 

  9. Furuichi S, Tobaru T, Asano R, Watanabe Y, Takamisawa I, Seki A, et al. Rotational atherectomy followed by cutting-balloon plaque modification for drug-eluting stent implantation in calcified coronary lesions. J Invasive Cardiol. 2012;24:191–5.

    PubMed  Google Scholar 

  10. Fujii N, Asano R, Nagayama M, Tobaru T, Misu K, Hasumi E, et al. Long-term outcome of first-generation metallic coronary stent implantation in patients with coronary artery disease: observational study over a decade. Circ J. 2007;71:1360–5.

    Article  PubMed  Google Scholar 

  11. Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med. 2011;364:1718–27.

    Article  PubMed  CAS  Google Scholar 

  12. Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med. 2008;358:1781–92.

    Article  PubMed  CAS  Google Scholar 

  13. Brener SJ, Galla JM, Bryant R 3rd, Sabik JF 3rd, Ellis SG. Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients. Am J Cardiol. 2008;101:169–72.

    Article  PubMed  Google Scholar 

  14. Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M, et al. Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience. Circulation. 2006;113:2542–7.

    Article  PubMed  CAS  Google Scholar 

  15. Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) trial. Circulation. 2010;121:2645–53.

    Article  PubMed  CAS  Google Scholar 

  16. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, SYNTAX Investigators, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    Article  PubMed  CAS  Google Scholar 

  17. Cao C, Manganas C, Bannon P, Vallely M, Yan TD. Drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of early outcomes from randomized and nonrandomized studies. J Thorac Cardiovasc Surg. 2013;145:738–47.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Ko Bando, MD for his extensive review and valuable comments.

Conflict of interest

The authors have declared that no conflict of interest exists.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Toshihiro Fukui, Minoru Tabata & Shuichiro Takanashi

  2. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Tetsuya Tobaru, Ryuta Asano & Tetsuya Sumiyoshi

Authors
  1. Toshihiro Fukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minoru Tabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Tobaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryuta Asano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuichiro Takanashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuya Sumiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshihiro Fukui.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fukui, T., Tabata, M., Tobaru, T. et al. Early and long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention in patients with left main disease: single-center results of multidisciplinary decision making. Gen Thorac Cardiovasc Surg 62, 301–307 (2014). https://doi.org/10.1007/s11748-013-0357-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-013-0357-7

Keywords

Search

Navigation