[Long-term outcomes of patients with unprotected left main coronary artery disease post revascularization]
Xianpeng Yu1, Shuzheng Lyu1, Jiqiang He1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Percutaneous coronary intervention (PCI) with drug-eluting stents offers similar survival to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease. PCI patients had more repeat procedures but fewer strokes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Unprotected left main coronary artery disease (ULMCA) poses significant risks.
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG) are primary treatment options.
- Long-term real-world outcomes comparing these strategies for ULMCA are crucial for clinical decision-making.
Purpose of the Study:
- To compare the long-term real-world outcomes of ULMCA patients treated with PCI (DES) versus CABG.
- To evaluate differences in mortality, myocardial infarction (MI), stroke, repeat revascularization, and major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- A consecutive cohort of 922 ULMCA patients (≥50% stenosis) treated between 2003-2009 at Beijing Anzhen Hospital were analyzed.
- Patients underwent either PCI with DES implantation or CABG.
- Follow-up extended to August 2013, with assessment of death, cardiac death, MI, stroke, and MACCE.
Main Results:
- After a median follow-up of 7.1 years, overall survival was similar between PCI and CABG groups.
- PCI was associated with a significantly higher rate of repeat revascularization (32.3% vs. 19.2%) but a significantly lower stroke rate (5.8% vs. 18.9%).
- MI rates were similar, and crude MACCE rates were comparable, though multivariate analysis showed higher MACCE in the PCI group due to repeat revascularization.
Conclusions:
- Long-term survival rates are comparable between PCI and CABG for ULMCA disease.
- PCI offers a lower stroke risk but necessitates a higher rate of repeat revascularization compared to CABG.
- These findings support shared decision-making based on individual patient factors and treatment risks.
Objective:
To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG).
Methods:
Consecutive patients with ULMCA (defined as stenosis ≥ 50%) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled. The follow-up period extended through August 2013. The end points of the study were death, cardiac death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization).
Results:
From January 2003 to July 2009, 922 ULMCA patients were enrolled in this study (465 PCI patients, and 457 CABG patients). The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years). The crude relative risk was as follows: overall death rate (13.0% (41/465) vs. 22.1% (72/457), P = 0.009), stroke rate (5.8% (11/465) vs. CABG 18.9% (46/457), P < 0.001) were significantly lower whereas the rate of repeat revascularization (32.3% (110/465) vs. CABG 19.2% (58/457), P < 0.001) was significantly higher in PCI group than in CABG group. MI rate was similar between PCI and CABG group (13.9% (33/465) vs. 6.7% (26/457), P = 0.196). MACCE rate was also similar between the 2 groups (42.9% (145/465) vs. 42.5% (142/457), P = 0.122). After multivariate adjusting, there was no significant difference in rates of death, MI and a composite of serious outcomes (cardiac death, MI, or stroke) between the 2 groups. Rates of MACCE were significantly higher in the PCI group (P = 0.009) due to increased rate of repeat revascularization (P < 0.001). However, stroke rate was still significantly higher in CABG group (P = 0.001) after multivariate adjusting.
Conclusion:
During a follow-up up to 8.2 years, the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease. The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.
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