MAINCOMPARE: PCV vs. CABG in LCMA Patients After 10 Years

Percutaneous coronary intervention (PCI) showed similar rates of death and serious composite outcomes compared with coronary-artery bypass grafting (CABG), but a higher rate of target-vessel revascularization at 10 years, in patients with significant left main coronary artery (LMCA) disease. However, researchers presenting findings from the MAINCOMPARE study at TCT 2018, also noted that CABG showed lower mortality and serious composite outcome rates compared to PCI with drug-eluting stents after five years.

The observational study of the MAINCOMPARE registry, which was also published in the Journal of the American College of Cardiology, evaluated 2,240 patients with unprotected LMCA disease who underwent PCI (N=1,102) or CABG (N=1138) between January 2000 and June 2006. Researchers compared adverse outcomes with the use of propensity scores and inverse-probability-weighting adjustment. All patients were followed-up for at least 10 years.

Overall results showed no significant difference in adjusted risks of death and the composite outcome between the two groups up to 10 years, although the risk of target-vessel revascularization was significantly higher in the PCI group. In a cohort comparing drug-eluting stents and concurrent CABG, the two study groups did not differ significantly in the risks of death and the composite outcome at five years. However, drug-eluting stents were associated with higher risks of death and serious composite outcomes compared with CABG after five years.

"Longer-term follow-up is necessary to examine additional differences between PCI and CABG over time in patients with significant LMCA disease," the researchers said. They also suggested their findings regarding DES should be "compared to those of the extended follow-up of EXCEL and NOBLE trials using contemporary DES."

Keywords: TCT18, Transcatheter Cardiovascular Therapeutics, Angiography, Percutaneous Coronary Intervention, Drug-Eluting Stents, Coronary Artery Disease, Follow-Up Studies, Coronary Restenosis, Angioplasty, Balloon, Coronary

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