1. MAIN-COMPARE Study
Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease

2. MAIN-COMPARE Study MAIN-COMPARE Study
Presented at ACC / i in Chicago
Presented by Dr. Seung-Jung Park
Copyleft Clinical Trial Results. You Must Redistribute Slides

3. MAIN-COMPARE Study: Background
Coronary artery bypass graft (CABG) surgery has been regarded as the standard of care in LMCA disease.
Early trials of LMCA disease treatment with drug eluting stents (DES) suggest promising outcomes with respect to mortality.
Presented at SCAI-i2 summit 08

4. MAIN-COMPARE Study: Study Design
2240 patients with unprotected left main artery disease, excluding those with prior CABG, valvular & aortic surgery, STEMI, or cardiogenic shock
Prospective. Non-randomized. Observational.
49% underwent stent implantation and 51% underwent CABG surgery R
Stent implantation
n=1102
CABG surgery
n=1138 R
DES n=784
BMS n=318
1017 days median follow-up
1152 days median follow-up
Primary Endpoint: Death; the composite of death, Q-wave myocardial infarction or stroke; target vessel revascularization (TVR).
Presented at SCAI-i2 summit 08 24

5. MAIN-COMPARE Study: Baseline Characteristics
Stents (n=1102 )
CABG (n=1138)
P value
Age (yr)
Median
Interquartile range 62
52-70 64
57-70
<0.001
Male (%)
70.7
72.9
0.24
Hypertension (%)
49.5
49.4
0.94
Hyperlipidemia (%)
28.5
32.6
0.04
Current smoker (%)
25.6
29.8
0.03
Diabetes (%)
29.7
34.7
0.01
Prior PCI (%)
18.1 11
Prior CVA
7.1
7.3
0.84
Prior MI (%)
8.1
11.6
0.005
Copyleft Clinical Trial Results. You Must Redistribute Slides
Presented at SCAI-i2 summit 08

6. MAIN-COMPARE Study: Angiographic Characteristics
Stents (n=1102 )
CABG (n=1138 )
P value
Involved location (% patients)
0.04
LM ostium, mid shaft/ both (%)
50.6
46.2
Distal bifurcation (%)
49.4
53.8
Extent of disease vessel (% pts)
<0.001
Left main only (%)
25.2
6.2
LM+ 1 vessel disease (%)
24.0
10.5
LM+ 2 vessel disease (%)
26.0
26.3
LM+ 3 vessel disease (%)
24.8
57.0
Copyleft Clinical Trial Results. You Must Redistribute Slides
Presented at SCAI-i2 summit 08

7. MAIN-COMPARE Study: Endpoints Overall cohort
Events HR
95% CI
P value
Death
1.18
0.45
Composite (death, Q-wave MI, or stroke)
1.10
0.61
TVR
4.76
p<0.001
HR is risk of stenting in excess of CABG
Copyleft Clinical Trial Results. You Must Redistribute Slides
Presented at SCAI-i2 summit 08 7

8. MAIN-COMPARE Study: Endpoints BMS vs. CABG
Events HR
95% CI
P value
Death
1.04
0.90
Composite
(death, Q-wave MI, or stroke)
0.86
0.59
TVR
10.70
p<0.001
HR is risk of stenting in excess of CABG
Copyleft Clinical Trial Results. You Must Redistribute Slides
Presented at SCAI-i2 summit 08 8

9. MAIN-COMPARE Study: Endpoints DES vs. CABG
Events HR
95% CI
P value
Death
1.36
0.26
Composite
(death, Q-wave MI, or stroke)
1.40
0.15
TVR
5.96
p<0.001
Copyleft Clinical Trial Results. You Must Redistribute Slides
Presented at SCAI-i2 summit 08 9

10. MAIN-COMPARE Study: Limitations
This was a non-randomized, observational study, thus the results may have been influenced by confounders.
Additionally, a larger sample size is needed to appropriately power the study in order to detect significant differences in mortality.
Presented at SCAI-i2 summit 08

11. MAIN-COMPARE Study: Summary
The results of this study suggest that there is no significant difference in the mortality rate or the composite risk of death, Q-wave MI or stroke among patients with unprotected LMCA disease who undergo PCI vs. CABG.
However, CABG was associated with significant reduction in the incidence of target vessel revascularization compared to PCI.
Presented at SCAI-i2 summit 08