Left Main Coronary Artery Disease: Not Just for Bypass Anymore?

In a randomized study, stent implantation compared well with CABG in most outcome measures.

Accumulating observational and secondary trial data suggest that clinical outcomes of percutaneous coronary intervention (PCI) are comparable to those of coronary artery bypass grafting (CABG) in patients with left main (LM) coronary artery disease. In the Korean, multicenter, partially manufacturer-funded PRECOMBAT trial, investigators randomized 600 adults (mean age, 62; 77% men) with unprotected LM stenoses >50% to receive sirolimus-eluting stents or CABG. Most patients also had multivessel disease (>70%), LM bifurcation disease (>60%), or SYNTAX scores for disease complexity of >19 (>60%).

Complete revascularization was achieved in about two thirds of patients in both groups. The primary endpoint (a composite of death, myocardial infarct…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI