Matched Analysis of Surgical versus Percutaneous Revascularization for Left Main Coronary Disease.

Abstract Background Percutaneous coronary intervention (PCI) is being performed more frequently for left main coronary artery disease (LMCAD). This study evaluated a real-world propensity-matched analysis of surgical versus percutaneous revascularization for LMCAD. Methods Adults (≥18 years) at a single academic institution undergoing coronary artery bypass grafting (CABG) or PCI for left main stenosis ≥50% between 2010-2018 were examined. Greedy propensity-matching techniques were used to generate well-matched cohorts, and Kaplan-Meier analysis was used to compare survival. Multivariable Cox models were created for 5-year mortality and major adverse cardiac and cerebrovascular events (MACCE). Results 1091 with LMCAD were identified (898 CABG, 193 PCI). Patients undergoing PCI were significantly older (77 vs 68 years, p Conclusions This real-world, propensity-matched analysis demonstrates substantial advantages in survival and MACCE with CABG for LMCAD, supporting surgical revascularization in this clinical setting in appropriate operative candidates.