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Daoulah A, Abozenah M, Alshehri M, Hersi AS, Yousif N, Garni TA, Abuelatta R, Almahmeed W, Alasmari A, Alzahrani B, Ghani MA, Amin H, Hashmani S, Hiremath N, Alharbi AW, Kazim HM, Refaat W, Selim E, Dahdouh Z, Aithal J, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Hussien AF, Abdulhabeeb IAM, Ahmad O, Ramadan M, Alqahtani AH, Ahmed FA, Qenawi W, Shawky A, Ghonim AA, Jamjoom A, El-Sayed O, Elmahrouk A, Elfarnawany A, Elsheikh-Mohamed NE, Abumelha BK, Shawky AM, Arafat AA, Naser MJ, Elmahrouk Y, Alhamid S, Lotfi A. Unprotected Left Main Revascularization in the Setting of Non-Coronary Atherosclerosis: Gulf Left Main Registry. Curr Probl Cardiol 2022; 48:101424. [PMID: 36167223 DOI: 10.1016/j.cpcardiol.2022.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in revascularization of left main coronary artery (LMCA) disease has been evaluated in previous studies. However, there has been minimal study of the relationship between co-existing non-coronary atherosclerosis (NCA) and LMCA disease revascularization. We aim to examine this relationship. METHODS The Gulf-LM study is a retrospective analysis of unprotected LMCA revascularization cases undergoing PCI with second generation drug-eluting stent versus CABG across 14 centers within 3 Gulf countries between January 2015 and December 2019. A total of 2138 patients were included, 381 with coexisting NCA and 1757 without. Outcomes examined included major adverse cardiovascular and cerebrovascular events (MACCE), cardiac and non-cardiac death, and all bleeding. RESULTS In patients with NCA, preexisting myocardial infarction and congestive heart failure were more common, with PCI being the most common revascularization strategy. A statistically significant reduction in in-hospital MACCE and all bleeding was noted in patients with NCA undergoing PCI as compared to CABG. At a median follow-up of 15 months, MACCE and major bleeding outcomes continued to favor the PCI group, though no such difference was identified between revascularization strategies in patients without NCA. CONCLUSIONS In this multicenter retrospective study of patients with and without NCA who require revascularization (PCI and CABG) for unprotected LMCA disease, PCI demonstrated a better clinical outcome in MACCE both in-hospital and during the short-term follow-up in patients with NCA. However, no such difference was observed in patients without NCA.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammed Abozenah
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts 01199
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, UAE
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | | | | | - Ahmad W Alharbi
- Department of of Internal Medicine, Gastroenterology Section, Gastroenterologist & Advanced Therapeutic Endoscopist, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Hameedullah M Kazim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia
| | - Adnan Fathey Hussien
- Department of cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, king Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fatima Ali Ahmed
- King Abdul Aziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia; Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Amr Elfarnawany
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Nezar Essam Elsheikh-Mohamed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Bader K Abumelha
- Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Abeer M Shawky
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Egypt
| | - Maryam Jameel Naser
- Department of Internal Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, MA
| | | | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts 01199
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van Zandvoort LJC, van Bommel RJ, Masdjedi K, Tovar Forero MN, Lemmert MM, Wilschut J, Diletti R, de Jaegere PPT, Zijlstra F, van Mieghem NM, Daemen J. Long-term outcome in patients treated with first- versus second-generation drug-eluting stents for the treatment of unprotected left main coronary artery stenosis. Catheter Cardiovasc Interv 2020; 95:1085-1091. [PMID: 31301161 DOI: 10.1002/ccd.28387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/01/2019] [Accepted: 06/22/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND BACKGROUND The study aim is to provide long-term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first-generation (1st -gen) drug-eluting stents (DES) in comparison to 2nd -gen DES, since this is largely unknown. METHODS Between May 2002, and December 2014, a consecutive series of 656 all-comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1st -gen DES, while a total of 421 patients were treated with 2nd -gen DES. RESULTS Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow-up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all-cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1st - and 2nd -gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94-1.74]). No difference was found in the individual endpoints of all-cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84-1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78-3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59-2.29]) between the 1st - and 2nd -gen DES cohorts, respectively. CONCLUSIONS In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1st versus 2nd -gen DES at 5 years follow-up.
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Affiliation(s)
| | - Rutger J van Bommel
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | | | - Miguel M Lemmert
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Joost Daemen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
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