Drug Eluting Stent for Left Main Coronary Artery Disease: The DELTA Registry: A Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment

Jul 18, 2012
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Authors:
Chieffo A, Meliga E, Latib A, et al.
Citation:
JACC Cardiovasc Interv 2012;5:718-727.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the outcome of a large cohort of patients undergoing percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) in unprotected left main coronary artery (ULMCA) stenosis?

Methods:

The authors compared the outcome of 2,775 patients undergoing PCI versus CABG for ULMCA stenosis and enrolled in a multinational registry.

Results:

Of the total cohort of 2,775 patients, 1,874 were treated with PCI and 901 underwent CABG. At a follow-up of 1,295 days, there were no differences in the primary composite endpoint of death, cerebrovascular accidents, and myocardial infarction (MI) (adjusted hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.85-1.42; p = 0.47), mortality (adjusted HR, 1.16; 95% CI, 0.87-1.55; p = 0.32), or composite endpoint of death and MI (adjusted HR, 1.25; 95% CI, 0.95-1.64; p = 0.11). An advantage of CABG over PCI was observed in the composite secondary endpoint of major adverse cardiac and cerebrovascular events (MACCE) (adjusted HR, 1.64; 95% CI, 1.33-2.03; p < 0.0001) driven by the higher incidence of target vessel revascularization with PCI.

Conclusions:

There was no difference in the occurrence of death, cerebrovascular accidents, and MI between patients treated with PCI or CABG for ULMCA disease. An advantage of CABG over PCI was observed in the incidence of MACCE, driven by the higher incidence of target vessel revascularization with PCI.

Perspective:

The optimal revascularization strategy for ULMCA disease remains debatable, with an increasing body of data supporting the safety and efficacy of PCI for lesions that do not involve the left main bifurcation. The main advantage of CABG over PCI is the reduced need for further revascularization; further studies are needed to assess if the use of PCI with subsequent CABG (in the event of restenosis) is as safe and efficacious as upfront CABG.

Keywords: Constriction, Registries, Coronary Artery Disease, Myocardial Infarction, Stroke, Follow-Up Studies, Coronary Stenosis, Drug-Eluting Stents, Confidence Intervals, Coronary Artery Bypass, Angioplasty, Percutaneous Coronary Intervention


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