Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected
Amin Daoulah1, Abdulrahman H Alqahtani2, Ahmed Elmahrouk3,4
1Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia. amindaoulah@yahoo.com.
Insights
Percutaneous coronary intervention (PCI) may be superior to coronary artery bypass grafting (CABG) for emergent left main coronary artery (LMCA) disease. PCI also showed benefits in non-emergent cases with specific risk scores.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Optimal revascularization for left main coronary artery (LMCA) disease in emergency settings remains debated.
- Comparison of percutaneous coronary interventions (PCI) versus coronary artery bypass grafting (CABG) is crucial for LMCA disease management.
Purpose of the Study:
- To compare outcomes of PCI versus CABG in patients with and without emergent LMCA disease.
- To evaluate in-hospital and follow-up mortality and major adverse cardiovascular and cerebrovascular events (MACCE).
Main Methods:
- Retrospective cohort study of 2138 patients from 14 centers (2015-2019).
- Comparison of emergent and non-emergent LMCA revascularization using PCI versus CABG.
- Outcomes assessed: all-cause mortality and MACCE.
Main Results:
- In emergent cases, PCI showed significantly lower MACCE and in-hospital mortality compared to CABG.
- For non-emergent LMCA disease, PCI was associated with lower MACCE and hospital mortality in patients with specific EuroSCORE and SYNTAX score profiles.
- At 20-month follow-up, emergency PCI demonstrated lower MACCE than CABG, with no significant difference in all-cause mortality.
Conclusions:
- PCI may offer advantages over CABG for emergent LMCA revascularization.
- PCI is a preferred option for non-emergent LMCA disease in patients with intermediate EuroSCORE and low-to-intermediate SYNTAX scores.
Background:
The optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease.
Methods:
This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE).
Results:
Emergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10-37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14-0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23-6.08), P = 0.845].
Conclusions:
PCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview