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Hirnle G, Stankiewicz A, Mitrosz M, Aboul-Hassan SS, Kocańda S, Deja M, Rogowski J, Cichoń R, Pawliszak W, Bugajski P, Tobota Z, Maruszewski B, Knapik P, Krejca M, Cisowski M, Hrapkowicz T. Does the Coronary Artery Bypass Grafting Impact the Survival of Men and Women Equally Compared to General Population? Results from KROK Registry and Polish Central Statistical Office. J Clin Med 2024; 13:7440. [PMID: 39685898 DOI: 10.3390/jcm13237440] [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: 09/22/2024] [Revised: 10/26/2024] [Accepted: 12/04/2024] [Indexed: 12/18/2024] Open
Abstract
Objective: The aim of this study was to evaluate the impact of coronary bypass surgery (CABG) on long-term mortality, comparing survival rates to those of the general population in Poland. Methods: The study was based on the Polish National Register of Cardiothoracic Surgical Procedures (KROK). Between January 2009 and December 2019, 133,973 patients underwent CABG. The study included all patients who underwent primary CABG. After excluding reoperations and patients with missing key data, there were 132,760 remaining patients who participated in the study. In order to compare patients who underwent CABG with the general population, data from Polish life expectancy tables from the Central Statistical Office (CSO) were used. Results: In the general population (GP), there is a consistent decrease in survival for both women and men throughout the entire observation period. The decline in survivability is more pronounced in the male group. Unlike the CABG group, which is at risk of perioperative mortality, there is no initial drop in survivability in the GP. The early mortality rate in CABG group within 30 days was significantly higher in the group of women than in men (3.51% compared to 2.19%, p < 0.001). The annual mortality rate was higher in the group of women (6.7% vs. 5.14%), and survival time was shorter (345.5 ± 0.4 vs. 351.2 ± 0.2 days, p < 0.001). However, the total mortality over a 13-year period of observation did not differ significantly between the groups (30.17% for women vs. 29.6% for men, p = 0.996) with survival time 10.08 ± 0.02 years in men vs. 10.06 ± 0.03 in women, p = 0.996. Conclusions: CABG surgery equalizes the probability of survival between genders. In long-term observation men have a greater survival benefit than women if compared to the predicted survival of the general population. These observations may provide a new perspective on the choice of revascularization strategy in relation to gender.
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Affiliation(s)
- Grzegorz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Białystok, Poland
| | - Adrian Stankiewicz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Białystok, Poland
| | - Maciej Mitrosz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Białystok, Poland
| | - Sleiman Sebastian Aboul-Hassan
- Department of Cardiac Surgery, Zbigniew Religa Heart Center "Medinet", 67-100 Nowa Sol, Poland
- Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Szymon Kocańda
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Białystok, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Medical Centre, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Romuald Cichoń
- Department of Cardiac Surgery, Zbigniew Religa Heart Center "Medinet", 67-100 Nowa Sol, Poland
- Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Wojciech Pawliszak
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, 85-094 Bydgoszcz, Poland
| | - Paweł Bugajski
- Department of Cardiac Surgery, J. Struś Hospital, Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Zdzisław Tobota
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, 04-730 Warszawa, Poland
| | - Bohdan Maruszewski
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, 04-730 Warszawa, Poland
| | - Piotr Knapik
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, 40-055 Zabrze, Poland
| | - Michał Krejca
- Department of Cardiac Surgery, Medical University of Lodz, 90-419 Łódź, Poland
| | - Marek Cisowski
- Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac Surgery, Vascular and Endovascular Surgery, and Heart Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, 40-055 Zabrze, Poland
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De Filippo O, Di Franco A, Improta R, Di Pietro G, Leone A, Pecoraro M, Meynet P, Carbone ML, Di Lorenzo E, Bruno F, Demetres M, Carmeci A, Conrotto F, Mancone M, De Ferrari GM, Gaudino M, D'Ascenzo F. Percutaneous coronary intervention versus coronary artery bypass grafting for left main disease according to age: A meta-analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00654-8. [PMID: 39067814 DOI: 10.1016/j.jtcvs.2024.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/15/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy.
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy
| | - Attilio Leone
- Division of Cardiology, SG Moscati Hospital, Avellino, Italy; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Martina Pecoraro
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pierre Meynet
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Luisa Carbone
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Antonino Carmeci
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
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Carvalho PEP, Veiga TMA, Machado FSL, Porto GV, Pirez J, Rivera M, Melo PC, Braghiroli J, Cardoso R. Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials. J Card Surg 2022; 37:4646-4653. [PMID: 36259716 DOI: 10.1111/jocs.17046] [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: 07/23/2022] [Revised: 08/29/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established. OBJECTIVES To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD. METHODS MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I2 = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I2 = 0%). CONCLUSION In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.
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Affiliation(s)
- Pedro E P Carvalho
- Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thiago M A Veiga
- Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Felipe S L Machado
- Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gabriel V Porto
- Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Manuel Rivera
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Pedro C Melo
- Cardiovascular Research Foundation, New York, New York, USA
| | | | - Rhanderson Cardoso
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rigatelli G, Zuin M, Gianese F, Adami D, Carraro M, Roncon L. Single versus Double Stenting in NSTEMI Patients with Complex Left Main Bifurcation Disease. J Clin Med 2022; 11:jcm11123559. [PMID: 35743629 PMCID: PMC9225359 DOI: 10.3390/jcm11123559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Among patients with non-ST-segment elevation myocardial infarction (NSTEMI) the presence of a bifurcation left main (LM) disease represents a particular subset graved by both clinical and technical challenges. We sought to assess the long-term outcomes of patients with NSTEMI treated either by single or double stent strategy, having an LM bifurcation culprit lesion. Methods: We retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for NSTEMI due to complex LM bifurcation disease as the culprit lesion, treated using either single or dual stenting (provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT)) techniques between January 2008 and May 2018. Target lesion failure (TLF) was defined as the composite of cardiovascular death, target-vessel myocardial infarction (MI), and clinically driven target lesion revascularization (TLR). Results: Four hundred and forty-five patients (54.1% males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3) were evaluated. Of these, 155 patients (34.8%) were treated using a single stent while the remaining were treated with a double stent strategy. After a mean follow-up of 37.1 months (IQR 22.1-39.3), TLF rate was 8.7% (n = 39): 5/155 (3.2%) in the crossover group; 10/53 (18.8%) in T/TAP group, 14/89 (15.7%) in the culotte group, and 10/148 (6.7%) in the NIT group of patients. Cardiovascular mortality rate was 2.9% (n = 13) while stent thrombosis was 0.89% (n = 4). On multivariate analysis dyslipidemia, Syntax score > 25, triple vessel disease, additional LM ostial, or LM body lesions and the use of Rotablator, were independent predictors of TLF. Conclusions: Either a single or double stent strategy resulted in low rates of TLF, cardiovascular death, and stent thrombosis in the long-term period in NSTEMI LM patients with contraindications or refusal of surgery. A single stent strategy appeared to have a slightly better outcome compared to a 2-stent strategy.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Department of Specialistic Medicine, Rovigo General Hospital, 45100 Rovigo, Italy; (F.G.); (D.A.)
- Correspondence: ; Tel.: +39-0425394509; Fax: +39-0425394513
| | - Marco Zuin
- Department of Translational Medicine, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Filippo Gianese
- Cardiovascular Diagnosis and Endoluminal Interventions, Department of Specialistic Medicine, Rovigo General Hospital, 45100 Rovigo, Italy; (F.G.); (D.A.)
| | - Dario Adami
- Cardiovascular Diagnosis and Endoluminal Interventions, Department of Specialistic Medicine, Rovigo General Hospital, 45100 Rovigo, Italy; (F.G.); (D.A.)
| | - Mauro Carraro
- Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, 45100 Rovigo, Italy; (M.C.); (L.R.)
| | - Loris Roncon
- Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, 45100 Rovigo, Italy; (M.C.); (L.R.)
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Almas T, Afzal A, Fatima H, Yaqoob S, Ahmad Jarullah F, Ahmed Abbasi Z, Farooqui A, Jaffar D, Batool A, Ahmed S, Sara Azmat N, Afzal F, Zafar Khan S, Fatima K. Safety and efficacy of percutaneous coronary intervention versus coronary artery bypass graft in patients with STEMI and unprotected left main stem disease: A systematic review & meta-analysis. IJC HEART & VASCULATURE 2022; 40:101041. [PMID: 35655530 PMCID: PMC9152298 DOI: 10.1016/j.ijcha.2022.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Introduction Owing to its large area of supply, left main coronary artery disease (LMCAD) has the highest mortality rate among coronary artery lesions, resulting in debate about its optimal revascularization technique. This meta-analysis compares percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for the treatment of LMCAD. Method MEDLINE, TRIP, and Cochrane Central databases were queried from their inception until 25 April 2021, to determine MACCE (major adverse cardiac and cardiovascular events), all-cause mortality, repeat revascularization, myocardial infarction (MI) and stroke rates post-revascularization for different follow-ups. 7 RCTs and 50 observational studies having 56,701 patients were included. A random-effects model was used with effect sizes calculated as odds ratios (odds ratio, OR). Results In the short term (1 year), PCI had significantly higher repeat revascularizations (OR = 3.58, 95% CI 2.47-5.20; p < 0.00001), but lower strokes (OR = 0.55, 95% CI 0.38-0.81; p = 0.002). In the intermediate term (2-5 years), PCI had significantly higher rates of repeat revascularizations (OR = 3.47, 95% CI 2.72-4.44; p < 0.00001) and MI (OR = 1.39, 95% CI 1.17-1.64; p = 0.0002), but significantly lower strokes (OR = 0.54, 95% CI 0.42-0.70; p < 0.0001). PCI also had significantly higher repeat revascularizations (OR = 2.58, 95% CI 1.89-3.52; p < 0.00001) in the long term (≥5 years), while in the very long term (≥10 years), PCI had significantly lower all-cause mortalities (OR = 0.77, 95% CI 0.61-0.96; p = 0.02). Conclusion PCI was safer than CABG for patients with stroke for most follow-ups, while CABG was associated with lower repeat revascularizations. However, further research is required to determine PCI's safety over CABG for reducing post-surgery MI.
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Affiliation(s)
- Talal Almas
- Department of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ahson Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hameeda Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sadia Yaqoob
- Department of Medicine, Jinnah Medical & Dental College, Karachi, Pakistan
| | | | - Zaeem Ahmed Abbasi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Anoosh Farooqui
- Department of Medicine, United Medical and Dental College, Karachi, Pakistan
| | - Duaa Jaffar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Atiya Batool
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Shayan Ahmed
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Neha Sara Azmat
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Fatima Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarah Zafar Khan
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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d'Entremont MA, Yagi R, Salia SJS, Zhang S, Shaban L, Bene-Alhasan Y, Papatheodorou S, Couture ÉL, Huynh T, Nguyen M, Hamaya R. The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis. J Cardiothorac Surg 2022; 17:61. [PMID: 35365159 PMCID: PMC8973812 DOI: 10.1186/s13019-022-01795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era. Methods We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for effect measure modification (EMM) by diabetes for adverse events. We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4356 patients, mean follow-up of 4.9 years) and six observational studies (9360 patients, mean follow-up of 5.2 years). Results In RCTs among DM patients, DES-based PCI, compared to CABG, was associated with a 30% increased relative risk (RR) (RR 1.30, 95% CI 1.09–1.56, I2 = 0%), while among non-DM patients, there was a 25% increased relative risk (RR 1.25, 95% CI 1.07–1.44, I2 = 0%) for the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization (MACCE). There was no evidence of EMM (p-value for interaction = 0.70). The mean weighted SYNTAX score was 25.7. In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (RR 1.13, 95% CI 0.91–1.40, I2 = 0%). Conclusions CABG was superior to PCI for LMCAD in RCTs in DM patients for MACCE. Heart teams may consider DM as one of the many components in the clinical decision-making process, but may not want to consider DM as a primary deciding factor between DES-based PCI and CABG for LMCAD with low to intermediate anatomical complexity in the other coronary arteries. Study registration CRD42021246931 (PROSPERO). Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01795-w.
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Affiliation(s)
- Marc-André d'Entremont
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ryuichiro Yagi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Saiseikai Central Hospital, Tokyo, Japan
| | | | - Shuqi Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lamyaa Shaban
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Étienne L Couture
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Thao Huynh
- McGill Health University Center, Montreal, QC, Canada
| | - Michel Nguyen
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Rikuta Hamaya
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Rajachandran M, Makhija R. PCI or CABG for Left Main Disease: Does Disease Location Matter? Curr Cardiol Rep 2022; 24:93-101. [PMID: 35038131 DOI: 10.1007/s11886-021-01629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review attempts to specifically assess impact of disease location in left main artery on mortality and cardiovascular outcomes in patients treated with percutaneous coronary intervention versus coronary artery bypass surgery. RECENT FINDINGS The management of left main disease, once thought to be the sole province of cardiothoracic surgeon, has recently undergone a reappraisal by the cardiovascular medicine community. For many years, societal guideline recommendations advised bypass surgery as the "de rigeur" method of revascularization for unprotected left main disease. However, recent studies suggest that coronary intervention, especially with advances in drug-eluting stent technology, has mounted a serious challenge to surgical bypass in treatment of this disease. Although overall mortality rates are comparable for percutaneous coronary intervention and bypass surgery, left main disease location does influence long-term outcomes for percutaneous coronary intervention more than bypass surgery. A patient- and lesion-centered approach to treatment of this disease may provide optimal outcomes.
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Affiliation(s)
- Manu Rajachandran
- Division of Cardiology, Medicine/Cardiology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, Associate Professor, El Paso, TX, USA.
| | - Rakhee Makhija
- Division of Cardiovascular Medicine, Texas Tech University, El Paso, TX, USA
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Shekhar S, Mohananey D, Villablanca P, Tyagi S, Crestanello JA, Gil IJN, Ramakrishna H. Revascularization Strategies for Stable Left Main Coronary Artery Disease: Analysis of Current Evidence. J Cardiothorac Vasc Anesth 2021; 36:3370-3378. [PMID: 35115224 DOI: 10.1053/j.jvca.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sudhi Tyagi
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Iván J Núñez Gil
- Interventional Cardiology Consultant, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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10
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Meta-Analysis Comparing the Risk of Myocardial Infarction Following Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Multivessel or Left Main Coronary Artery Disease. Am J Cardiol 2019; 124:842-850. [PMID: 31311660 DOI: 10.1016/j.amjcard.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 11/21/2022]
Abstract
There is insufficient data regarding the comparative efficacy of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) regarding myocardial infarction (MI). Our systematic review included randomized controlled trials that compared CABG versus PCI with stents in patients with multivessel or left main coronary artery disease (CAD). Included trials should have had reported event number of MI and a clinical follow-up of one or more years. Data were pooled using a random-effects model. The primary end point was MI at the longest available follow-up in the intention-to-treat population. Fifteen trials with a total of 13,592 patients treated with either CABG (n = 6,596) or PCI (n = 6,996) were included. After a weighted follow-up of 4.5 years, patients treated with CABG had a significantly lower risk of MI than those treated with PCI (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.96, p = 0.024). The lower risk of MI with CABG as compared with PCI was more evident during a longer duration of follow-up (≥3 years, RR 0.69, 95% CI 0.52 to 0.91, p = 0.008; ≥5 years, RR 0.64, 95% CI 0.48 to 0.86, p = 0.003) and in the diabetic population (RR 0.55, 95% CI 0.44 to 0.70, p <0.001). The magnitude of risk reduction was similar across patients with multivessel (RR 0.72, 95% CI 0.53 to 0.99) and left main CAD (RR 0.74, 95% CI 0.47 to 1.15). In conclusion, the present meta-analysis of studies involving patients with multivessel or left main CAD suggests a significant benefit of CABG over PCI concerning the risk of future MI.
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Cui K, Lyu S, Song X, Liu H, Yuan F, Xu F, Zhang M, Wang W, Zhang M, Zhang D, Tian J. Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic Patients With Multivessel and/or Left Main Coronary Artery Disease: A Meta-Analysis. Angiology 2019; 70:765-773. [PMID: 30995117 DOI: 10.1177/0003319719839885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
With the development of stent design and surgical techniques, the relative benefit of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and complex coronary artery disease are highly debated. This meta-analysis was conducted to compare the outcomes of drug-eluting stent (DES) implantation and CABG in these cohorts. A comprehensive search of PubMed, Embase, and Cochrane Library up to January 4, 2018, was performed. Only randomized controlled trials (RCTs), subgroup analysis from RCTs, or adjusted observational studies were eligible. Five RCTs and 13 adjusted observational studies involving 17 532 patients were included. Overall, PCI with DES was significantly associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization (HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk of stroke was significantly lower in the DES group (HR: 0.67, 95% CI: 0.54-0.83). The incidence of the composite end point of death, MI, or stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17). Despite the higher risk of stroke, CABG was better than PCI with DES for diabetic patients with multivessel and/or left main coronary artery disease.
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Affiliation(s)
- Kongyong Cui
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shuzheng Lyu
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiantao Song
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Hong Liu
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fei Yuan
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Feng Xu
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Mingduo Zhang
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dongfeng Zhang
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jinfan Tian
- 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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