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Randomized Controlled Trial
. 2015 May 26;65(20):2198-206.
doi: 10.1016/j.jacc.2015.03.033. Epub 2015 Mar 15.

Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study

Jung-Min Ahn  1 , Jae-Hyung Roh  1 , Young-Hak Kim  1 , Duk-Woo Park  1 , Sung-Cheol Yun  2 , Pil Hyung Lee  1 , Mineok Chang  1 , Hyun Woo Park  1 , Seung-Whan Lee  1 , Cheol Whan Lee  1 , Seong-Wook Park  1 , Suk Jung Choo  1 , CheolHyun Chung  1 , JaeWon Lee  1 , Do-Sun Lim  3 , Seung-Woon Rha  4 , Sang-Gon Lee  5 , Hyeon-Cheol Gwon  6 , Hyo-Soo Kim  7 , In-Ho Chae  8 , Yangsoo Jang  9 , Myung-Ho Jeong  10 , Seung-Jea Tahk  11 , Ki Bae Seung  12 , Seung-Jung Park  13
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Free article
Randomized Controlled Trial

Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study

Jung-Min Ahn et al. J Am Coll Cardiol. .
Free article

Abstract

Background: In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year.

Objectives: This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.

Methods: We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.

Results: At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).

Conclusions: During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968).

Keywords: coronary artery bypass grafting; long-term outcome; percutaneous coronary intervention.

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