MAIN-COMPARE 10-Year Data Published

December 4, 2018—In Journal of the American College of Cardiology (JACC), Duk-Woo Park, MD, et al published 10-year outcomes from the multicenter observational MAIN-COMPARE registry studying revascularization for unprotected left main coronary artery (LMCA) stenosis by percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).

As summarized in JACC, the investigators evaluated 2,240 patients with unprotected LMCA disease who underwent PCI (n = 1,102) or CABG (n = 1,138) between January 2000 and June 2006. Adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target vessel revascularization) were compared with the use of propensity scores and inverse probability weighting adjustment. The follow-up was extended to at least 10 years for all patients (median, 12.0 years).

The investigators reported that in the overall cohort, there was no significant difference in adjusted risks of death and the composite outcome between the groups up to 10 years and that the risk of target vessel revascularization was significantly higher in the PCI group.

In the cohort comparing drug-eluting stents and concurrent CABG, the two study groups did not significantly differ in the risks of death and the composite outcome at 5 years. However, after 5 years, drug-eluting stents were associated with higher risks of death (hazard ratio, 1.35; 95% confidence interval, 1.00–1.81) and the composite outcome (hazard ratio, 1.46; 95% confidence interval, 1.10–1.94) compared with CABG.

The data showed that in patients with significant LMCA disease, PCI and CABG showed similar rates of death and serious composite outcomes but that PCI had a higher rate of target vessel revascularization at 10 years. However, it was also noted that CABG carried lower mortality and serious composite outcome rates compared with drug-eluting stent PCI after 5 years, according to the investigators in JACC.