Intravascular Imaging-Guided Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for
Wojciech Wańha1,2,3, Łukasz Kuźma3,4,5,6, Michał Święczkowski4
1Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
Insights
Intravascular imaging-guided percutaneous coronary intervention (PCI) offers similar 2-year outcomes to coronary artery bypass grafting (CABG) for left main coronary artery stenosis. PCI showed reduced major adverse cardiac and cerebrovascular events in less complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) has historically shown lower repeat revascularization rates compared to percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) stenosis.
- Left main coronary artery stenosis is a critical condition requiring effective treatment strategies.
Purpose of the Study:
- To compare the clinical outcomes of intravascular imaging (IVI)-guided PCI versus CABG in patients with LMCA stenosis.
- To evaluate the safety and efficacy of IVI-guided PCI as an alternative to CABG for LMCA disease.
Main Methods:
- A multi-center study involving 855 patients undergoing treatment for LMCA stenosis.
- Propensity score matching (PSM) was employed to create comparable groups for PCI and CABG.
- The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 2 years, including cardiovascular death, myocardial infarction, stroke, and target vessel revascularization.
Main Results:
- No significant difference in MACCE was observed between IVI-guided PCI and CABG in the overall cohort or matched groups.
- CABG was associated with lower rates of myocardial infarction, while PCI showed a trend towards higher stroke incidence.
- No significant difference in target vessel revascularization or all-cause mortality was found between the two treatment groups at 2 years.
Conclusions:
- IVI-guided PCI provides comparable 2-year clinical outcomes to CABG for LMCA stenosis.
- PCI may offer advantages in patients with lower anatomical complexity, warranting further investigation.
Background:
Randomized clinical trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) stenosis have indicated lower repeat revascularization after CABG.
Aim:
This multi-center study aimed to investigate outcomes of intravascular imaging (IVI)-guided PCI compared with CABG for treating LMCA stenosis.
Methods:
Analysis included 855 patients (396 PCI) from 18 centers. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE: cardiovascular death, myocardial infarction, stroke, and target vessel revascularization at 2 years). Propensity score matching (PSM) analysis was used to limit differences among the groups. Cox regression event rates were calculated for matched groups.
Results:
In the overall cohort, no difference in MACCE was observed (HR 0.97, 95% CI 0.72-1.32, p = 0.84). PSM resulted in 230 pairs, with no significant differences in baseline, procedural characteristics, and SYNTAX score between the two groups. The matched cohorts had no significant differences for the primary endpoint (HR 0.85, 95% CI 0.65-1.43, p = 0.85). No differences for all-cause mortality rates between the two groups were found at 2 years (10% in the PCI and 11% in the CABG arm, p = 0.65). During follow-up, patients undergoing CABG had lower rates of myocardial infarction (8.7% vs. 14.8%, p = 0.04). More frequent stroke incidence was noticed (8.7% vs. 0%, p < 0.001). There was no significant difference in the incidence of target vessel revascularization between PCI and CABG (3.91% vs. 2.61%, p = 0.43).
Conclusions:
IVI-guided PCI for LMCA stenosis provides similar 2-year outcomes to CABG. Lower MACCE rates with PCI were observed in patients with lower anatomic complexity.
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