Comparison Between Coronary Angioplasty and Coronary Artery Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Stenosis (the Bologna Registry) Tullio Palmerini, MD a, *, Antonio Marzocchi, MD a , Cinzia Marrozzini, MD a , Paolo Ortolani, MD a , Francesco Saia, MD, PhD a , Carlo Savini, MD b , Letizia Bacchi-Reggiani, BSc a , Silvia Gianstefani, MD a , Santo Virzì, MD a , Francesca Manara, MD a , Meron Kiros Weldeab, MD a , Giuseppe Marinelli, MD b , Roberto Di Bartolomeo, MD b , and Angelo Branzi, MD a Although great interest exists in the relative efficacy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for the treatment of unprotected left main coronary artery stenosis, data comparing the 2 strategies are scant. Furthermore, no comparison has ever been performed between CABG and drug-eluting stents in this setting. From January 2002 to June 2005, 154 patients with unprotected left main coronary artery stenosis underwent CABG and 157 underwent PCI. Ninety-four patients received a drug-eluting stent in the left main artery. After a median follow-up of 430 days, the rate of mortality, acute myocardial infarction, and target lesion revascularization was 12.3%, 4.5%, and 2.6%, respectively, in the CABG group and 13.4%, 8.3%, and 25.5%, respec- tively, in the PCI group (death and myocardial infarction p  NS, target lesion revascu- larization p  0.0001). Although patients treated with drug-eluting stents had a 25% relative risk reduction in the rate of death, myocardial infarction, and target lesion revascularization compared with patients treated with bare stents, event-free survival was still better for patients treated with CABG. In the multivariate analysis, age >70 years, New York Heart Association classes III and IV, acute coronary syndromes, and peripheral vascular disease were the only independent predictors of mortality. In conclusion, our results have indicated that at long-term follow-up no difference exists in the rate of mortality and myocardial infarction between PCI and CABG for the treatment of unpro- tected left main coronary artery stenosis. However, the rate of target lesion revasculariza- tion was higher in the PCI group. © 2006 Elsevier Inc. All rights reserved. (Am J Cardiol 2006;98:54 –59) In this study, we report the results of the “Bologna Registry for the treatment of unprotected left main coronary artery (ULMCA) stenosis,” an observational study of unselected patients with ULMCA stenosis treated with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods Patients: Since January 2002, all patients with a de novo 50% ULMCA stenosis treated with either PCI or CABG have been prospectively collected in a specific database (Bologna Registry for the treatment of ULMCA stenosis). In the present analysis, we included patients enrolled from January 1, 2002 to June 30, 2005. The exclusion criteria were acute myocardial infarction with ST-segment eleva- tion, hemodynamic instability, valve repair or replacement, previous CABG, and history of neoplastic condition in the preceding 5 years. The decision to perform CABG or PCI was taken according to referent physician’s preference or patient’s choice. To better characterize patients in relation to the strategy of revascularization adopted, we performed a post hoc analysis to determine how many patients were believed to be appropriate only for CABG, how many were appropriate only for PCI and how many might be eligible in a randomized trial. Patients were defined to be trial eligible if PCI for ULMCA was considered technically feasible, if an equivalent degree of revascularization could be provided by the 2 strategies of revascularization, if a mammary artery could be used to bypass the left anterior descending coro- nary artery, and if the general condition of the patient was considered suitable for surgical intervention. Each coronary angiogram was reviewed by 1 interventional cardiologist and 1 cardiac surgeon, and an agreement on the best strategy of revascularization was achieved in all cases. All patients provided written, informed consent for participation in the a Istituto di Cardiologia and b Istituto di Cardiochirurgia, Policlinico S. Orsola, University of Bologna, Bologna, Italy. Manuscript received De- cember 9, 2005; revised manuscript received and accepted January 12, 2006. This study was supported by funds from the Fondazione Fanti Melloni, Bologna, Italy. * Corresponding author: Tel: 0039-051-349-858; fax: 0039-051-344- 859. E-mail address: tulliopalmerini@hotmail.com (T. Palmerini). 0002-9149/06/$ – see front matter © 2006 Elsevier Inc. All rights reserved. www.AJConline.org doi:10.1016/j.amjcard.2006.01.070