Treatment of patients with left main coronary artery (LMCA) disease and moderate to severe left ventricular (LV) dysfunction using percutaneous coronary intervention (PCI) was associated with worse long-term outcomes compared with the use of coronary artery bypass grafting (CABG) surgery, according to a study published in the Journal of the American College of Cardiology.
In this study, the data of patients with unprotected LMCA disease from the Interventional Research Incorporation Society-Left MAIN Revascularization registry were examined. A total of 3488 patients with LMCA disease who underwent CABG (n=1355) or PCI with stenting (n=2133) were included in this study (median follow-up, 3.8 years; interquartile range, 2.1-5.5 years).
Patients were classified based on severity of LV dysfunction, as assessed by LV ejection fraction (LVEF), with normal function defined as LVEF ≥55%, mild dysfunction as LVEF ≥45% and <55%, moderate dysfunction as LVEF ≥35% and <45%, and severe dysfunction as LVEF <35%. The primary outcome of the analysis was a composite endpoint of death, myocardial infarction, or stroke.
A total of 75.7% of patients had normal LVEF at baseline, 11.6% had mild LV dysfunction, 7.5% had moderate LV dysfunction, and 5.3% had severe LV dysfunction. The use of PCI was associated with a greater risk for the primary composite outcome in patients with moderate (hazard ratio [HR], 2.23; 95% CI, 1.17-4.28; P =.02) and severe (HR, 2.45; 95% CI, 1.27-4.73; P =.008) LV dysfunction.
The primary outcome was comparable after PCI and CABG in patients with normal (HR, 0.80; 95% CI, 0.59-1.07; P =.13) or mild (HR, 1.17; 95% CI, 0.63-2.17; P =.61) LV dysfunction.
Study limitations include its nonrandomized design and the small percentage of patients with moderate or severe LV dysfunction.
“These findings suggest that the severity of LV dysfunction should be considered as the key factor for the decision making of the optimal revascularization choice for patients with LMCA disease,” concluded the study authors.
Park S, Ahn JM, Kim TO, et al. Revascularization in patients with left main coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2020;76(12):1395-1406. doi:10.1016/j.jacc.2020.07.047