Long-term prognosis in ethnic Chinese patients with unprotected left main coronary artery disease.

OBJECTIVE: The aim of this study was to investigate the long-term outcome of unprotected left main coronary artery disease (LMCA) with different therapeutic modalities in Chinese patients.
BACKGROUND: Coronary artery bypass graft (CABG) has been considered standard therapy for patients with LMCA disease. Percutaneous coronary intervention (PCI) has recently been alternative choice for unprotected LMCA. Nevertheless, the effects on the long-term outcome of unprotected LMCA by the above-mentioned management in Chinese remains unknown.
METHODS: Patients with unprotected LMCA were enrolled at National Taiwan University Hospital from January 1996 to June 2006. Survival outcomes were obtained by the Bureau of National Health Insurance and clinical results were obtained by chart record review and telephone interview.
RESULTS: A total of 620 patients with a mean age of 67 +/- 10 years were enrolled and followed up for 1,587 +/- 1,136 days. Of these, 136 were treated with medical therapy, 336 with CABG and 148 with PCI. Clinical outcome of patients receiving medical therapy was the worst. There was no significant difference between the PCI and CABG group in the risk of cardiovascular death. Cox regression analysis showed that cardiovascular mortality was significantly associated with age (P < 0.001), diabetes mellitus (P = 0.004), LVEF (P = 0.001). In high-risk left ventricular dysfunction, the elderly and renal insufficiency patients, the long-term survival was statistically significantly better in the CABG group.
CONCLUSION: For Chinese patients with unprotected left main coronary artery disease, a significant higher risk of cardiovascular death was noted in the medical therapy group. Overall the long-term cardiovascular survival was similar in LMCA patients treated with either PCI or CABG, but CABG provided better survival outcome in high-risk subgroup patients.