Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 3-Year Clinical Outcomes Depending on SYNTAX Score

The purpose of our study was to compare the 3-year of follow-up clinical outcomes in patients suffering from left main coronary artery disease (LMCAD) treated either by percutaneous coronary intervention (PCI) or by coronary artery bypass grafting (CABG) depending on SYNTAX score tertiles. The primary end point of the study was all-cause mortality for the PCI arm versus CABG arm depending on SYNTAX score tertiles. The secondary end points were the recurrence of angina pectoris following revascularization, the acute nonfatal myocardial infarction, the reduction of the left ventricular ejection fraction or the need for myocardial revascularization. With regard to patients with LMCAD, at low risk (SYNTAX score 0-22) there was no difference in the frequency of end-point occurrence among patients treated by PCI compared to CABG. Also, the tendency to increase end point occurrence in patients with LMCAD treated by PCI compared to patients treated by CABG was more evident in patients at intermediate risk, but the significant statistical difference was recorded only in the occurrence of acute myocardial infarction. Regarding the patients with LMCAD at high risk (SYNTAX score over 33) the endpoint occurrence was significantly increased, statistically significant differences were recorded in all evaluated endpoints. In conclusion, coronary artery bypass grafting remains the standard treatment for high-risk patients with complex lesions, while for patients with LMCAD at low or intermediate risk, percutaneous coronary intervention by stent implantation remains an alternative that does not pose significant risks.