OBJECTIVE

To determine the most optimal method for myocardial revascularization in patients with multiple-vessel coronary disease involving left main coronary artery (LMA) depending on Syntax Score (SS).

MATERIAL AND METHODS

There were 313 patients with multiple-vessel coronary disease involving LMA who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for the period from 2010 to 2019. Mean follow-up period was 44±25 months.

RESULTS

There were no significant differences in combined primary endpoint (mortality, myocardial infarction, stroke, repeated myocardial revascularization) or its individual parameters. Major adverse cardiovascular events (MACE) were observed in 13.9% of patients after PCI and 14.8% of patients after CABG (relative risk (RR) 0.94, 95% CI 0.54—1.61, p=0.82). In patients with SS ≤32, MACE were detected in 11.2% of patients vs. 11.9% of patients in the PCI and CABG groups, respectively (RR 0.94, 95% CI 0.47—1.89, p=0.87). In patients with high SS, MACE were observed in 26.9% of cases after PCI and 22.7% of patients after CABG (RR 1.18, 95% CI 0.51—2.73, p=0.69).

CONCLUSION

PCI with the newest generations of everolimus-eluting stents and CABG ensure comparable high clinical efficacy and safety in long-term postoperative period in patients with multiple-vessel coronary disease involving left main coronary artery.