Percutaneous Coronary Intervention Vs Coronary Artery Bypass Surgery for Unprotected Left Main Coronary Disease: G-LM
Amin Daoulah1, Abdulaziz Alasmari1, Ahmad S Hersi2
1Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
Insights
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) shows comparable outcomes to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCA) in Gulf countries. Further follow-up is needed to confirm long-term efficacy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass surgery (CABG) is the standard for unprotected left main coronary artery disease (ULMCA).
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as an alternative treatment option.
- Data comparing PCI and CABG for ULMCA in the Gulf region is limited.
Purpose of the Study:
- To compare the clinical outcomes of PCI versus CABG for revascularization in patients with ULMCA.
- To evaluate the safety and efficacy of PCI with DES compared to CABG in a multi-center cohort from three Gulf countries.
Main Methods:
- Retrospective analysis of 2138 ULMCA patients (1222 PCI, 916 CABG) from 14 centers in Saudi Arabia, UAE, and Bahrain (Jan 2015-Dec 2019).
- Comparison of in-hospital outcomes and major adverse cardiovascular and cerebrovascular events (MACCE) at a median 15-month follow-up.
- Inclusion of patients treated with PCI using DES.
Main Results:
- PCI patients were older with higher comorbidities and lower ejection fractions.
- Higher rates of aborted cardiac arrest and cardiogenic shock were observed in the PCI group at presentation.
- In-hospital mortality and MACCE were higher in the CABG group.
- No significant difference in freedom from revascularization, MACCE, or total mortality at follow-up between PCI and CABG groups.
Conclusions:
- PCI with DES is a viable alternative to CABG for ULMCA in the Gulf region, demonstrating similar clinical outcomes at mid-term follow-up.
- Findings align with Western data, suggesting PCI's efficacy in selected ULMCA patients.
- Long-term follow-up is crucial to confirm sustained outcomes and safety profiles.
Abstract:
Coronary artery bypass surgery (CABG) has been the standard of care for revascularization for patients with obstructive unprotected left main coronary disease (ULMCA). There have been multiple randomized and registry data demonstrating the technical and clinical efficacy of PCI in certain patients with ULMCA. The purpose of this study is to evaluate clinical outcomes of ULMCA PCI as compared to CABG in patients requiring revascularization in three Gulf countries. All ULMCA cases treated by PCI with DES versus CABG were retrospectively identified from 14 centers in 3 Arab Gulf countries (KSA, UAE, and Bahrain) from January 2015 to December 2019. In total, 2138 patients were included: 1222 were treated with PCI versus 916 with CABG. Patients undergoing PCI were older, and had higher comorbidities and mean European System for Cardiac Operative Risk Evaluation (EuroSCORE). Aborted cardiac arrest and cardiogenic shock were reported more in the PCI group at hospital presentation. In addition, lower ejection fractions were reported in the PCI group. In hospital mortality and major adverse cardiovascular and cerebrovascular events (MACCE) occurred more in patients undergoing CABG than PCI. At median follow-up of 15 months (interquartile range, 30), no difference was observed in freedom from revascularization, MACCE, or total mortality between those treated with PCI and CABG. While findings are similar to Western data registries, continued follow-up will be needed to ascertain whether this pattern continues into latter years.
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