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Ten-Year Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow-Up of the PRECOMBAT Trial

Authors
 Duk-Woo Park  ;  Jung-Min Ahn  ;  Hanbit Park  ;  Sung-Cheol Yun  ;  Do-Yoon Kang  ;  Pil Hyung Lee  ;  Young-Hak Kim  ;  Do-Sun Lim  ;  Seung-Woon Rha  ;  Gyung-Min Park  ;  Hyeon-Cheol Gwon  ;  Hyo-Soo Kim  ;  In-Ho Chae  ;  Yangsoo Jang  ;  Myung-Ho Jeong  ;  Seung-Jea Tahk  ;  Ki Bae Seung  ;  Seung-Jung Park 
Citation
 CIRCULATION, Vol.141(18) : 1437-1446, 2020-05 
Journal Title
CIRCULATION
ISSN
 0009-7322 
Issue Date
2020-05
MeSH
Aged ; Coronary Artery Bypass* / adverse effects ; Coronary Artery Bypass* / mortality ; Coronary Artery Disease / diagnostic imaging ; Coronary Artery Disease / mortality ; Coronary Artery Disease / therapy* ; Drug-Eluting Stents* ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention / adverse effects ; Percutaneous Coronary Intervention / instrumentation* ; Percutaneous Coronary Intervention / mortality ; Republic of Korea ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Keywords
coronary artery bypass grafting ; coronary artery disease ; drug-eluting stents ; outcome assessment ; percutaneous coronary intervention ; survival
Abstract
Background: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents and coronary-artery bypass grafting (CABG) for left main coronary artery disease are highly debated.

Methods: In the PRECOMBAT trial (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease), patients with unprotected left main coronary artery disease were randomly assigned to undergo PCI with sirolimus-eluting stents (n=300) or CABG (n=300) in 13 hospitals in Korea from April 2004 to August 2009. The follow-up was extended to at least 10 years for all patients (median, 11.3 years). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization).

Results: At 10 years, a primary outcome event occurred in 29.8% of the PCI group and in 24.7% of the CABG group (hazard ratio [HR] with PCI vs CABG, 1.25 [95% CI, 0.93-1.69]). The 10-year incidence of the composite of death, myocardial infarction, or stroke (18.2% vs 17.5%; HR 1.00 [95% CI, 0.70-1.44]) and all-cause mortality (14.5% vs 13.8%; HR 1.13 [95% CI, 0.75-1.70]) were not significantly different between the PCI and CABG groups. Ischemia-driven target-vessel revascularization was more frequent after PCI than after CABG (16.1% vs 8.0%; HR 1.98 [95% CI, 1.21-3.21).

Conclusions: Ten-year follow-up of the PRECOMBAT trial of patients with left main coronary artery disease randomized to PCI or CABG did not demonstrate significant difference in the incidence of major adverse cardiac or cerebrovascular events. Because the study was underpowered, the results should be considered hypothesis-generating, highlighting the need for further research. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03871127 and NCT00422968.
Full Text
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.046039
DOI
10.1161/CIRCULATIONAHA.120.046039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184993
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