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

Alaide Chieffo, Emanuele Meliga, Azeem Latib, Seung-Jung Park, Yoshinobu Onuma, Piera Capranzano, Marco Valgimigli, Sanda Jegere, Raj R Makkar, Igor F Palacios, Young-Hak Kim, Pawel E Buszman, Tarun Chakravarty, Imad Sheiban, Roxana Mehran, Christoph Naber, Ronan Margey, Arvind Agnihotri, Sebastiano Marra, Davide Capodanno, Martin B Leon, Jeffrey W Moses, Jean Fajadet, Thierry Lefevre, Marie-Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Patrick W Serruys, Antonio Colombo
JACC. Cardiovascular Interventions 2012, 5 (7): 718-27

OBJECTIVES: The aim of this study was to compare, in a large all-comers registry, major adverse cardiac and cerebrovascular events (MACCE) after 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.

BACKGROUND: Percutaneous coronary intervention with DES implantation in ULMCA has been shown to be a feasible and safe approach at midterm clinical follow-up.

METHODS: All consecutive patients with ULMCA stenosis treated by PCI with DES versus CABG were analyzed in this multinational registry. A propensity score analysis was performed to adjust for baseline differences in the overall cohort.

RESULTS: In total 2,775 patients were included: 1,874 were treated with PCI versus 901 with CABG. At 1,295 (interquartile range: 928 to 1,713) days, there were no differences, at the adjusted analysis, 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 to 1.42; p = 0.47), mortality (adjusted HR: 1.16; 95% CI: 0.87 to 1.55; p = 0.32), or composite endpoint of death and MI (adjusted HR: 1.25; 95% CI: 0.95 to 1.64; p = 0.11). An advantage of CABG over PCI was observed in the composite secondary endpoint of MACCE (adjusted HR: 1.64; 95% CI: 1.33 to 2.03; p < 0.0001), driven exclusively by the higher incidence of target vessel revascularization with PCI.

CONCLUSIONS: In our multinational all-comers registry, no difference was observed in the occurrence of death, cerebrovascular accidents, and MI between PCI and CABG. An advantage of CABG over PCI was observed in the incidence of MACCE, driven by the higher incidence of target vessel revascularization with PCI.

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