Long‐term trends of treatment effect of stenting or bypass surgery in patients with ostial or shaft left main coronary artery disease

Background Little is known about how the relative treatment effect of percutaneous coronary intervention (PCI) and coronary‐artery bypass grafting (CABG) on clinical outcomes in ostial or shaft left main coronary artery (LMCA) disease has evolved over time. Methods This study included 2,112 patients with ostial or shaft LMCA disease from IRIS‐MAIN registry who underwent PCI (n = 1,329) or CABG (n = 783). Patients were stratified by time period based on stent type availability: wave 1 (1995–2002, bare‐metal stent [BMS] era); wave 2 (2003–2006, first‐generation drug‐eluting stent [DES] era); and wave 3 (2007–2014, second‐generation DES era). Results Compared to CABG, PCI has been used more frequently from wave 1 to wave 3. PCI showed substantial improvements over time with respect to death (P for trend = 0.012); the composite of death, myocardial infarction (MI), or stroke (P for trend = 0.047); repeat revascularization (P for trend