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Left ventricular systolic dysfunction in patients with unprotected left main coronary artery disease

Yu Pan1, Qi Qiu2, Wei-Hong Ren3

  • 1Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.

Herz
|May 22, 2020
PubMed

Insights

For patients with unprotected left main coronary artery disease and left ventricular systolic dysfunction, drug-eluting stents (DES) offer similar safety and efficacy to coronary artery bypass grafting (CABG). DES is an acceptable alternative revascularization strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease with left ventricular systolic dysfunction (LVSD) is debated.
  • Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG) are primary treatment options.

Purpose of the Study:

  • To compare clinical outcomes of DES versus CABG in patients with ULMCA disease.
  • To evaluate outcomes stratified by the presence and severity of LVSD.

Main Methods:

  • Retrospective analysis of 984 patients with ULMCA disease.
  • Patients were treated with either DES (n=511) or CABG (n=473).
  • Outcomes were analyzed based on left ventricular ejection fraction levels.

Main Results:

  • No significant differences in major adverse cardiac and cerebral events, mortality, myocardial infarction, or stroke between DES and CABG groups, regardless of LVSD status.
  • Target vessel revascularization was higher in the DES group for patients without LVSD.
  • This difference in target vessel revascularization was not significant in patients with mild or severe LVSD.

Conclusions:

  • For ULMCA disease with LVSD, DES and CABG demonstrate comparable efficacy and safety.
  • DES is a viable alternative to CABG for this patient population.
Abstract

Keywords:
Coronary artery bypass graftingDrug-eluting stentMyocardial infarctionPercutaneous coronary interventionStroke

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