MAIN-COMPARE: Outcomes similar in CABG, PCI for left main CAD

Seung-Jung Park

SAN DIEGO — Patients with significant left main CAD who underwent PCI had similar rates of death and a composite outcome up to 10 years compared with those who underwent CABG, according to data from the MAIN-COMPARE registry presented at TCT 2018.

Perspective from C. Michael Gibson, MD, MS

PCI conferred increased rates of target vessel revascularization in the overall cohort, whereas among those whose procedures occurred in the drug-eluting stent era, CABG resulted in reduced risk for mortality and serious composite outcomes after 5 years.

“The treatment benefit of CABG has diverged over time during continued follow-up,” Seung-Jung Park, MD, PhD, professor of medicine at University of Ulsan College of Medicine in Seoul, South Korea, and a member of the Cardiology Today's Intervention Editorial Board, said during the press conference.

Researchers analyzed data from 2,240 patients with unprotected left main CAD who underwent either CABG (n = 1,138; mean age, 63 years; 73% men) or PCI (n = 1,102; mean age, 61 years; 71% men) in Korea between 2000 and June 2006. The treating physician and/or the patient decided with which revascularization strategy to proceed with based on surgical risk for CABG or clinical and anatomic factors.

PCI was performed with standard interventional techniques, and the operator decided on the use of IVUS and a specific stent. Bare-metal stents were implanted between 2000 and May 2003, and drug-eluting stents were implanted between May 2003 and June 2006.

The study endpoints of interest were all-cause death, TVR and a composite of Q-wave MI, all-cause death or stroke. Patients were followed up at 1 month, 6 months, 1 year and annually thereafter for a median of 12 years.

The PCI and CABG groups had similar 10-year rates of death (21.1% vs. 23.2%, respectively; P = .23) and the composite of Q-wave MI, death or stroke (23.8% vs. 26.3%, respectively; P = .13). The PCI group had a consistently higher risk for TVR compared with the CABG group (21.1% vs. 5.8%; P < .001).

In the DES era, up to 5 years, there were no significant differences between both groups in the risk for death (HR = 1.02; 95% CI, 0.71-1.46) and the composite risk for Q-wave MI, death or stroke (HR = 0.91; 95% CI, 0.66-1.27). The curves separated after 5 years, which showed that patients who underwent PCI with a DES had a significantly increased risk for death (HR = 1.35; 95% CI, 1-1.81) and a serious composite outcome (HR = 1.46; 95% CI, 1.1-1.94) compared with those who underwent CABG during the same period.

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“We evaluated the first generation of DES,” Park said during the press conference. “However, previous reports did not find any meaningful difference in outcomes among several types of first- and second-generation DES for [left-main coronary artery disease].” – by Darlene Dobkowski

Reference s :

Park SJ, et al. Late-Breaking Clinical Science 2. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.

Park DW, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.09.012.

Disclosure s : Park reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Perspective

C. Michael Gibson, MD, MS

This does not feature randomized data. It is hard to draw conclusions. It can tell you about who is getting what technique, but it cannot really be used to compare the two techniques.

C. Michael Gibson, MD, MS

Professor of Medicine

Harvard Medical School

Chief of Clinical Research

Beth Israel Deaconess Medical Center

Disclosures: Gibson reports he is CEO of the Baim Institute, a nonprofit organization which receives research grant support from device manufacturers.