The present observational study compares in-hospital and 12 month clinical outcomes in elderly patients (aged ≥ 75 years) with unprotected left main coronary artery (ULMCA) disease treated either with coronary artery bypass grafting (CABG) or drug eluting stent (DES).From January 2004 to December 2007, 211 patients (pts) with ULMCA stenosis, aged 75 or older, underwent a coronary revascularisation either with CABG (106 pts) or DES (105 pts). Decision to treat with CABG or PCI was dependent on the patient's and the physisican's choice. The occurrence of major adverse cardiac or cerebrovascular events (MACCE: death, non fatal myocardial infarction or stroke) and revascularisations was recorded after one year follow-up. A multivariate logistic regression analysis was performed, using a propensity score method to take into account potential baseline differences between groups.In-hospital MACCE rates were 5.7% and 3.8% in CABG and PCI groups, respectively (p=0.748). After, one-year follow-up, rates were respectively 15.4% and 16.3% (p=0.865). Rates for target vessel revascularisation at 12 months were 1.1% and 15.2% (p<0.001). PCI group was significantly associated with older age, dyslipidaemia, history of cancer, high euroscore, elevated creatininemia, single vessel disease, chronic occlusion of left anterior descending artery and LMCA stenosis ≥70%. The multivariable logistic regression analysis was adjusted for age, diabetes, left ventricular ejection fraction, euroscore, and stratified on the propensity score to be treated with PCI. In the subgroup below median propensity score, the adjusted odds ratio for one-year MACCE was OR=0.98 (95% confidence interval: 0.17 to 5.67; p=0.981) whereas OR was 0.20 (0.04 to 0.97; p=0.046) in the subgroup above median propensity score.In patients with a high probability to be treated with PCI (older age, high euroscore, high creatininemia, single vessel disease…), one-year risk of death was significantly lower in PCI as compared to CABG treated subjects. No significant difference was found in other cases.
