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Yoon JY, Lee JH, Kim HN, Kim N, Jang SY, Bae MH, Yang DH, Park HS, Cho Y. The novel bio-SYNTAX scoring system for predicting the prognosis of patients undergoing percutaneous coronary intervention with left main coronary artery disease. Front Cardiovasc Med 2022; 9:912286. [PMID: 36211557 PMCID: PMC9538309 DOI: 10.3389/fcvm.2022.912286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSimple and effective risk models incorporating biomarkers associated with left main coronary artery (LMCA) stenosis are limited. This study aimed to validate the novel Bio-Clinical SYNTAX score (Bio-CSS) incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with LMCA stenosis.MethodsPatients who underwent percutaneous coronary intervention (PCI) for LMCA stenosis using a drug-eluting stent (n = 275) were included in the study. We developed the Bio-CSS incorporating NT-proBNP and validated the ability of the Bio-CSS to predict major adverse cardiac events (MACEs) and compared its performance to that of the SYNTAX score (SS) and SS II. The MACEs were defined as death, non-fatal myocardial infarction (MI), and repeat revascularizations.ResultsThe Bio-CSS (34.7 ± 18.3 vs. 51.9 ± 28.4, p < 0.001), as well as SS (23.6 ± 7.3 vs. 26.7 ± 8.1, p = 0.003) and SS II (29.4 ± 9.9 vs. 36.1 ± 12.8, p < 0.001), was significantly higher in patients with MACEs. In the Cox proportional hazards model, the log Bio-CSS (hazard ratio 8.31, 95% CI 1.84–37.55) was an independent prognostic factor for MACEs after adjusting for confounding variables. In the receiver operating characteristic curves, the area under the curve of the Bio-CSS was significantly higher compared to those of SS (0.608 vs. 0.706, p = 0.001) and SS II (0.655 vs. 0.706, p = 0.026). Patients were categorized into the three groups based on the tertiles of the Bio-CSS. Patients in the highest tertile of the Bio-CSS had significantly higher MACEs compared to those in the lower two tertiles (log-rank p < 0.001).ConclusionIn patients who underwent PCI for LMCA stenosis, the novel Bio-CSS improved the discrimination accuracy of established combined scores, such as SS and SS II. The addition of NT-proBNP to the clinical and angiographic findings in the Bio-CSS could potentially provide useful long-term prognostic information in these patients.
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Affiliation(s)
- Jae Yong Yoon
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
- *Correspondence: Jang Hoon Lee
| | - Hong Nyun Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Se Yong Jang
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
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Ayman R, Shaheen SM, Sabet SS, Abdellatif YA. Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry. Egypt Heart J 2022; 74:63. [PMID: 36068451 PMCID: PMC9448832 DOI: 10.1186/s43044-022-00302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a “real-world” setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals). Results This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023). Conclusions LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.
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Outcomes of Left Main Revascularization after Percutaneous Intervention or Bypass Surgery. J Interv Cardiol 2022; 2022:6496777. [PMID: 35494423 PMCID: PMC9019449 DOI: 10.1155/2022/6496777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study is aimed at comparing the clinical outcomes of unprotected left main coronary artery disease (ULMCAD) treatment with contemporary percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a “real-world” population. Methods and Results Overall, 558 consecutive patients with ULMCAD (mean age 71 ± 9 years, male gender 81%) undergoing PCI or CABG were compared. The primary endpoint was the composite of death, nonfatal myocardial infarction, or stroke. Diabetes was present in 29% and acute coronary syndrome in 56%; mean EuroSCORE was 11 ± 8. High coronary complexity (SYNTAX score >32) was present in 50% of patients. The primary composite endpoint was similar after PCI and CABG up to 4 years (15.5 ± 3.1% vs. 17.1 ± 2.6%; p=0.585). The primary end point was also comparable in a two propensity score matched cohorts. Ischemia-driven revascularization was more frequently needed in PCI than in CABG (5.5% vs. 1.5%; p=0.010). By multivariate analysis, diabetes mellitus (HR 2.00; p=0.003) and EuroSCORE (HR 3.71; p < 0.001) were the only independent predictors associated with long-term outcome. Conclusions In a “real-world” population with ULMCAD, a contemporary revascularization strategy by PCI or CABG showed similar long-term clinical outcome regardless of the coronary complexity.
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Impact of intravascular ultrasound and final kissing balloon dilatation on long-term clinical outcome in percutaneous revascularization with 1-stent strategy for left main coronary artery stenosis in drug-eluting stent era. Coron Artery Dis 2022; 31:9-17. [PMID: 34569990 DOI: 10.1097/mca.0000000000001101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It remains uncertain whether intravascular ultrasound (IVUS) use and final kissing balloon (FKB) dilatation would be standard care of percutaneous coronary intervention (PCI) with a simple 1-stent technique in unprotected left main coronary artery (LMCA) stenosis. This study sought to investigate the impact of IVUS use and FKB dilatation on long-term major adverse cardiac events (MACEs) in PCI with a simple 1-stent technique for unprotected LMCA stenosis. METHODS Between June 2006 and December 2012, 255 patients who underwent PCI with 1 drug-eluting stent for LMCA stenosis were analyzed. Mean follow-up duration was 1663 ± 946 days. Long-term MACEs were defined as death, nonfatal myocardial infarction (MI) and repeat revascularizations. RESULTS During the follow-up, 72 (28.2%) MACEs occurred including 38 (14.9%) deaths, 21 (8.2%) nonfatal MIs and 13 (5.1%) revascularizations. The IVUS examination and FKB dilatation were done in 158 (62.0%) and 119 (46.7%), respectively. IVUS use (20.3 versus 41.2%; log-rank P < 0.001), not FKB dilatation (30.3 versus 26.5%; log-rank P = 0.614), significantly reduced MACEs. In multivariate analysis, IVUS use was a negative predictor of MACEs [hazards ratio 0.51; 95% confidence interval (CI) 0.29-0.88; P = 0.017], whereas FKB dilatation (hazard ratio 1.68; 95% CI, 1.01-2.80; P = 0.047) was a positive predictor of MACEs. In bifurcation LMCA stenosis, IVUS use (18.7 versus 48.0%; log-rank P < 0.001) significantly reduced MACEs. In nonbifurcation LMCA stenosis, FKB dilatation showed a trend of increased MACEs (P = 0.076). CONCLUSION IVUS examination is helpful in reducing clinical events in PCI for LMCA bifurcation lesions, whereas mandatory FKB dilatation after the 1-stent technique might be harmful in nonbifurcation LMCA stenosis.
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Almeida AS, Fuchs SC, Fuchs FC, Silva AG, Lucca MB, Scopel S, Fuchs FD. Effectiveness of Clinical, Surgical and Percutaneous Treatment to Prevent Cardiovascular Events in Patients Referred for Elective Coronary Angiography: An Observational Study. Vasc Health Risk Manag 2020; 16:285-297. [PMID: 32764949 PMCID: PMC7371461 DOI: 10.2147/vhrm.s246963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/26/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose To ascertain the most appropriate treatment for chronic, stable, coronary artery disease (CAD) in patients submitted to elective coronary angiography. Patients and Methods A total of 814 patients included in the prospective cohort study were referred for elective coronary angiography and were followed up on average for 6±1.9 years. Main outcomes were all-cause death, cardiovascular death, non-fatal myocardial infarction (MI) and stroke and late revascularization and their combinations as major adverse cardiac and cerebral events (MACCE): MACCE-1 included cardiovascular death, nonfatal MI, and stroke; MACCE-2 was MACCE-1 plus late revascularization. Survival curves and adjusted Cox proportional hazard models were used to explore the association between the type of treatment and outcomes. Results All-cause death was lower in participants submitted to percutaneous coronary intervention (PCI) (0.41, 0.16-1.03, P=0.057) compared to medical treatment (MT). Coronary-artery bypass grafting (CABG) had an overall trend for poorer outcomes: cardiovascular death 2.53 (0.42-15.10), combined cardiovascular death, nonfatal MI, and stroke 2.15 (0.73-6.31) and these events plus late revascularization (2.17, 0.86-5.49). The corresponding numbers for PCI were 0.27 (0.05-1.43) for cardiovascular death, 0.77 (0.32-1.84) for combined cardiovascular death, nonfatal MI, and stroke and 2.35 (1.16-4.77) with the addition of late revascularization. These trends were not influenced by baseline blood pressure, left ventricular ejection fraction and previous MI. Patients with diabetes mellitus had a significantly higher risk of recurrent revascularization when submitted to PCI than CABG. Conclusion Patients with confirmed CAD in elective coronary angiography do not have a better prognosis when submitted to CABG comparatively to medical treatment. Patients treated with PCI had a trend for the lower incidence of combined cardiovascular events, at the expense of additional revascularization procedures. Patients without significant CAD had a similar prognosis than CAD patients treated with medical therapy.
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Affiliation(s)
- Adriana Silveira Almeida
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandra C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felipe C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Aline Gonçalves Silva
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcelo Balbinot Lucca
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Samuel Scopel
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flávio D Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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6
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Pan Y, Qiu Q, Ren WH, Yu XP, Liu ZS, Dong JZ. Left ventricular systolic dysfunction in patients with unprotected left main coronary artery disease. Herz 2020; 46:262-268. [PMID: 32435839 DOI: 10.1007/s00059-020-04934-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/08/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal coronary revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease and left ventricular systolic dysfunction (LVSD) remains uncertain. The purpose of this study was to evaluate the clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) versus coronary artery bypass grafting (CABG) in patients with ULMCA disease with or without LVSD. METHODS A total of 984 patients with ULMCA disease who received a DES (n = 511) or underwent CABG (n = 473) were included in this study. We retrospectively analyzed the clinical parameters and outcomes of ULMCA disease patients with different left ventricular ejection fraction levels. RESULTS There were no significant differences in major adverse cardiac and cerebral events, all-cause death, cardiac death, myocardial infarction, or stroke between the CABG and DES groups with or without LVSD. The rate of target vessel revascularization was significantly higher with DES compared with CABG in patients without LVSD; however, the difference was not significant between the mild LVSD and severe LVSD groups. CONCLUSION For patients with ULMCA disease and LVSD, there was no significant difference between DES and CABG in terms of efficacy and safety. Treatment with DES was an acceptable alternative to CABG.
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Affiliation(s)
- Yu Pan
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Qi Qiu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei-Hong Ren
- Department of Pathology, Aviation General Hospital of China Medical University, China Medical University, Beijing, China
| | - Xian-Peng Yu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Ze-Sen Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
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Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome. J Interv Cardiol 2020; 2020:6980324. [PMID: 32327944 PMCID: PMC7166269 DOI: 10.1155/2020/6980324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/10/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p = 0.034), myocardial infarction (7.1% vs. 1.8%, p < 0.001), in-stent thrombosis (4.5% vs. 0.8%, p < 0.001), and stroke (7.1% vs. 6.4%, p = 0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243-5.347, p = 0.011). Conclusion LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.
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Khan MR, Kayani WT, Ahmad W, Manan M, Hira RS, Hamzeh I, Jneid H, Virani SS, Kleiman N, Lakkis N, Alam M. Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta-analysis and meta-regression. Clin Cardiol 2019; 42:1071-1078. [PMID: 31486094 PMCID: PMC6837018 DOI: 10.1002/clc.23253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. Methods We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. Results All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). Conclusions PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, Michigan
| | - Waleed T Kayani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Waqas Ahmad
- Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Malalai Manan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Ihab Hamzeh
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Neal Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Nasser Lakkis
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Mahboob Alam
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
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Wu P, Luo F, Fang Z. Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis. Cardiorenal Med 2019; 9:145-159. [PMID: 30844786 DOI: 10.1159/000494116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Early revascularization can lead to better prognosis in multivessel coronary artery disease (CAD) patients with chronic kidney disease (CKD). However, whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is better remains unknown. Methods: We searched PubMed and the Cochrane Library database from inception until December 9, 2017, for articles that compare outcomes of CABG and PCI in multivessel CAD patients with CKD. We pooled the odds ratios with a fixed-effects model when I2 < 50% or a random-effects model when I2 > 75% and conducted heterogeneity and quality assessments as well as publication bias analyses. Results: A total of 17 studies with 62,343 patients were included. Compared with CABG, the pooled analysis showed that PCI had a lower risk of short-term all-cause death (OR, 0.56; 95% CI, 0.37–0.84) and cerebrovascular accidents (OR, 0.65; 95% CI, 0.53–0.79) but a higher risk of cardiac death (OR, 1.29; 95% CI, 1.21–1.37), myocardial infarction (MI) (OR, 1.73; 95% CI, 1.35–2.21), and repeat revascularization (RR) (OR, 3.9; 95% CI, 2.99–5.09). There was no significant difference in the risk of long-term all-cause death (OR, 1.08; 95% CI, 0.95–1.23) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99–2.52) between the PCI and CABG groups. A subgroup analysis restricted to patients treated with dialysis or with PCI-drug-eluting stent yielded similar results. Conclusions: PCI for patients with CKD and multivessel disease (multivessel CAD) had advantages over CABG with regard to short-term all-cause death and cerebrovascular accidents, but disadvantages regarding the risk of myocardial death, MI, and RR; there was no significant difference in the risk of long-term all-cause death and MACCE. Large randomized controlled trials are needed to confirm our findings.
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Affiliation(s)
- Panyun Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,
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Wańha W, Mielczarek M, Smolka G, Roleder T, Jaguszewski M, Ciećwierz D, Tomasiewicz B, Kubler P, Gorol J, Chmielecki M, Bartuś S, Navarese EP, Kasprzak M, Sukiennik A, Kubica J, Lekston A, Hawranek M, Reczuch K, Gruchała M, Ochała A, Wojakowski W. Safety and efficacy of self-apposing Stentys drug-eluting stent in left main coronary artery PCI: Multicentre LM-STENTYS registry. Catheter Cardiovasc Interv 2019; 93:574-582. [PMID: 30311397 DOI: 10.1002/ccd.27876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/26/2018] [Accepted: 08/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a paucity of data on left main (LM) percutaneous coronary intervention (PCI) therapy with dedicated DES platforms. The LM-STENTYS is a multicenter registry aimed at evaluating clinical outcome after PCI of LM performed with a self-apposing Stentys DES implantation. METHODS The registry consists of 175 consecutive patients treated with Stentys DES implanted to LM. The primary endpoint was the composite of major adverse cardiac and cerebral events (MACCE) defined as cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed after 1 year. The secondary endpoint was stent thrombosis (ST) at 1 year. RESULTS The median age was 69 years (IQR, 62-78 years). Acute coronary syndrome (ACS) was the presenting diagnosis in 117 (66.9%) patients [74 (63.2%) unstable angina, 31 (26.5%) NSTEMI, 12 (10.3%) STEMI] and stable angina (SA) was present in 58 (33.1%) patients. The median SYNTAX score was 23.0 (IQR, 18.7-32.2) in the SA group and 25.0 (IQR, 20.0-30.7) in the ACS group. During 1-year follow-up in the SA group two (3.4%) MACCE occurred, both of them were cardiac deaths. In ACS patients there were 19 (16.2%) MACCE [9 (7.7%) cardiac deaths, 11 (9.4%) MIs, 11(9.4%) TLR, 1(0.9%) stroke]. Altogether, three (1.7%) cases of acute ST were noted, all of them in ACS subset. CONCLUSION LM PCI using self-apposing Stentys DES showed favorable clinical outcomes at 1-year in patients with SA. Events of ST in the ACS group warrant further research.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Roleder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Brunon Tomasiewicz
- Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Kubler
- Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jarosław Gorol
- Third Department of Cardiology, Medical University of Katowice, Zabrze, Poland
| | - Michał Chmielecki
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Eliano Pio Navarese
- INOVA Heart and Vascular Institute, Virginia.,Interventional Cardiology and Cardiovascular Medicine Research, Cardiovascular Research Center, Mater Dei Hospital, Bari, Italy.,SIRIO MEDICINE Research Network, Düsseldorf, Germany
| | - Michał Kasprzak
- Department of Cardiology Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Adam Sukiennik
- Department of Cardiology Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Medical University of Katowice, Zabrze, Poland
| | - Michał Hawranek
- Third Department of Cardiology, Medical University of Katowice, Zabrze, Poland
| | - Krzysztof Reczuch
- Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Chieffo A, Tanaka A, Giustino G, Briede I, Sawaya FJ, Daemen J, Kawamoto H, Meliga E, D'Ascenzo F, Cerrato E, Stefanini GG, Capodanno D, Mangiameli A, Templin C, Erglis A, Morice MC, Mehran R, Van Mieghem NM, Nakamura S, De Benedictis M, Pavani M, Varbella F, Pisaniello M, Sharma SK, Tamburino C, Tchetche D, Colombo A. The DELTA 2 Registry: A Multicenter Registry Evaluating Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents in Patients With Obstructive Left Main Coronary Artery Disease. JACC Cardiovasc Interv 2018; 10:2401-2410. [PMID: 29217002 DOI: 10.1016/j.jcin.2017.08.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate clinical outcomes of unprotected left main coronary artery percutaneous coronary intervention (PCI) with new-generation drug-eluting stents in a "real world" population. BACKGROUND PCI of the unprotected left main coronary artery is currently recommended as an alternative to coronary artery bypass grafting (CABG) in selected patients. METHODS All consecutive patients with unprotected left main coronary artery stenosis treated by PCI with second-generation drug-eluting stents were analyzed in this international, all-comers, multicenter registry. The results were compared with those from the historical DELTA 1 (Drug Eluting Stent for Left Main Coronary Artery) CABG cohort using propensity score stratification. The primary endpoint was the composite of death, myocardial infarction (MI), or stroke at the median time of follow-up. RESULTS A total of 3,986 patients were included. The mean age was 69.6 ± 10.9 years, diabetes was present in 30.8%, and 21% of the patients presented with acute MI. The distal left main coronary artery was involved in 84.6% of the lesions. At a median of 501 days (≈17 months) of follow-up, the occurrence of the primary endpoint of death, MI, or cerebrovascular accident was lower in the PCI DELTA 2 group compared with the historical DELTA 1 CABG cohort (10.3% vs. 11.6%; adjusted hazard ratio: 0.73; 95% confidence interval: 0.55 to 0.98; p = 0.03). Of note, an advantage of PCI was observed with respect to cerebrovascular accident (0.8% vs. 2.0%; adjusted hazard ratio: 0.37; 95% confidence interval: 0.16 to 0.86; p = 0.02), while an advantage of CABG was observed with respect to target vessel revascularization (14.2% vs. 2.9%; adjusted hazard ratio: 3.32; 95% confidence interval: 2.12 to 5.18; p < 0.0001). CONCLUSIONS After a median follow-up period of 17 months, PCI with new-generation drug-eluting stents was associated with an overall low rate of the composite endpoint of death, MI, or cerebrovascular accident.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Akihito Tanaka
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Ieva Briede
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Fadi J Sawaya
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Joost Daemen
- Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | | | | | - Fabrizio D'Ascenzo
- Department of Internal Medicine, Division of Cardiology, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | | | | | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Marie Claude Morice
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | | | - Marco Pavani
- Department of Internal Medicine, Division of Cardiology, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Ferdinando Varbella
- San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
| | - Marco Pisaniello
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | | | | | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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12
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Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease: a meta-analysis. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:162-172. [PMID: 29662510 PMCID: PMC5895956 DOI: 10.11909/j.issn.1671-5411.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent (DES) is safe and effective compared to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease at long-term follow up (≥ 3 years). Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction (MI) or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint (HR = 0.94, 95% CI: 0.86–1.03). Besides, DES was significantly associated with higher incidence of MI (HR = 1.56, 95% CI: 1.09–2.22) and repeat revascularization (HR = 3.09, 95% CI: 2.33–4.10) compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke (HR = 0.80, 95% CI: 0.67–0.95) for ULMCA lesions with SYNTAX score ≤ 32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.
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13
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Kang SH, Ahn JM, Lee CH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication: Insights From a Large International Multicenter Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004988. [PMID: 28701487 DOI: 10.1161/circinterventions.116.004988] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies. METHODS AND RESULTS The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608). We analyzed the incidence and independent predictors of major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) and all-cause mortality in each treatment stratum. During follow-up (median, 4.3 years), the rates of MACCE and death were substantially higher in the medical group than in the percutaneous coronary intervention and coronary-artery bypass grafting groups (P<0.001). In the percutaneous coronary intervention group, the 3 strongest predictors for MACCE were chronic renal failure, old age (≥65 years), and previous heart failure; those for all-cause mortality were chronic renal failure, old age, and low ejection fraction. In the coronary-artery bypass grafting group, old age, chronic renal failure, and low ejection fraction were the 3 strongest predictors of MACCE and death. In the medication group, old age, low ejection fraction, and diabetes mellitus were the 3 strongest predictors of MACCE and death. CONCLUSIONS Among patients with unprotected left main coronary artery disease, the key clinical predictors for MACCE and death were generally similar regardless of index treatment. This study provides effect estimates for clinically relevant predictors of long-term clinical outcomes in real-world left main coronary artery patients, providing possible guidance for tailored preventive strategies. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT01341327.
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Affiliation(s)
- Se Hun Kang
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Jung-Min Ahn
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Cheol Hyun Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Pil Hyung Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Soo-Jin Kang
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Seung-Whan Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Young-Hak Kim
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Cheol Whan Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Seong-Wook Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Duk-Woo Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.).
| | - Seung-Jung Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
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14
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Kodumuri V, Balasubramanian S, Vij A, Siddamsetti S, Sethi A, Khalafallah R, Khosla S. A Meta-Analysis Comparing Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Disease. Am J Cardiol 2018; 121:924-933. [PMID: 29502793 DOI: 10.1016/j.amjcard.2017.12.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/16/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022]
Abstract
Coronary artery bypass grafting (CABG) is the preferred revascularization strategy for unprotected left main disease (UPLMD). Multiple small-scale trials and registry data showed that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a noninferior strategy with a Class IIa American College of Cardiology/American Heart Association recommendation in patients with high surgical risk and favorable anatomy. However, 2 recent large-scale randomized trials showed conflicting evidence. We conducted a meta-analysis of the existing data to compare outcomes of PCI with DES versus CABG for UPLMD. Four randomized and 8 nonrandomized trials involving 10,284 patients were included. Primary end point was composite of death, stroke, or myocardial infarction (MI) at 3 years or longer. Secondary end points were MACCE (Major Adverse Cardiac and Cerebrovascular Events) and its individual components (death, stroke, MI, or repeat revascularization). Mantel-Haenszel random effects model was used to calculate combined odds ratio for outcomes. A separate analysis of randomized data was also performed. There was no significant difference in primary composite outcome between PCI and CABG. However, MACCE was significantly higher in PCI, primarily driven by significantly high repeat revascularization. A subgroup analysis stratified by Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed that MACCE and repeat revascularization were not significantly different between PCI and CABG in low to intermediate SYNTAX score (<33), whereas they were significantly higher in PCI with higher SYNTAX score. Thus, although CABG remains the preferred method of treatment in UPLMD, PCI with DES can be considered as a reasonable alternative in patients with favorable anatomy and high surgical risk.
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Affiliation(s)
- Vamsi Kodumuri
- Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.
| | | | - Aviral Vij
- Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Sisir Siddamsetti
- Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Ankur Sethi
- Department of Cardiology, Chicago Cardiology Institute, Schaumberg, Illinois
| | - Rommy Khalafallah
- Department of Biology, Loyola University Health System, Maywood, Illinois
| | - Sandeep Khosla
- Department of Cardiology, Rosalind Franklin University of Medicine and Sciences, North Chicago, Illinois
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15
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Takagi H, Ando T, Umemoto T. Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease. Catheter Cardiovasc Interv 2018; 91:697-709. [PMID: 28799701 DOI: 10.1002/ccd.27235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/16/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To compare follow-up outcomes after percutaneous coronary intervention with drug-eluting stents (DES-PCI) versus coronary artery bypass grafting (CABG) for left-main coronary artery disease (LMCAD), we performed a meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity-score analysis. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through November 2016. Eligible studies were RCTs or observational studies with propensity-score analysis of DES-PCI versus CABG enrolling patients with LMCAD and reporting ≥ 6-month mortality, myocardial infarction (MI), stroke, or repeat revascularization (RRV). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios (HRs) in the random-effects model. RESULTS We identified 5 RCTs and 17 observational studies with propensity-score analysis enrolling a total of 12,387 patients. Pooled analysis demonstrated a significant increase in a composite of death, MI, and RRV (with/without stroke) after DES-PCI (HR, 1.42; P < 0.00001); no significant difference in a composite of death and MI (with/without stroke); no significant differences in mortality and stroke; a strong trend toward an increase in MI after DES-PCI (HR, 1.44; P = 0.05); and significant increases in any (HR, 1.86; P < 0.00001), target-vessel (HR, 3.28; P < 0.00001), and target-lesion RRV (HR, 2.26; P = 0.003) after DES-PCI. CONCLUSIONS When compared with CABG, DES-PCI for LMCAD was associated with increases in RRV and the composite of death, MI, and RRV (with/without stroke), despite no differences in mortality, MI, stroke, and the composite of death and MI (with/without stroke).
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, Michigan
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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16
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Khan MR, Kayani WT, Ahmad W, Hira RS, Virani SS, Hamzeh I, Jneid H, Lakkis N, Alam M. Meta-Analysis of Comparison of 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery in the Era of Drug-eluting Stents. Am J Cardiol 2017; 120:1514-1520. [PMID: 28886851 DOI: 10.1016/j.amjcard.2017.07.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are increasingly being treated with percutaneous coronary intervention (PCI) using drug-eluting stents (DES), but long-term outcomes comparing PCI with coronary artery bypass grafting (CABG) remain limited. We performed aggregate data meta-analyses of clinical outcomes (all-cause death, nonfatal myocardial infarction, stroke, repeat revascularization, cardiac death, and major adverse cardiac and cerebrovascular events) in studies comparing 5-year outcomes of PCI with DES versus CABG in patients with ULMCA disease. A comprehensive literature search (January 1, 2003 to December 10, 2016) identified 9 studies (6,637 patients). Effect size for individual clinical outcomes was estimated using odds ratio (OR) with 95% confidence intervals (CI) using a random effects model. At 5 years, PCI with DES was associated with equivalent cardiac (OR 0.95, 95% CI 0.62 to 1.46) and all-cause mortality (OR 0.98, 95% CI 0.72 to 1.33), lower rates of stroke (OR 0.50, 95% CI 0.30 to 0.84), and higher rates of repeat revascularization (OR 2.52, 95% CI 1.63 to 3.91); compared with CABG, major adverse cardiac and cerebrovascular events showed a trend favoring CABG but did not reach statistical significance (OR 1.19, 95% CI 0.93 to 1.54). In conclusion, for ULMCA disease, PCI can be considered as a comparably effective and yet less invasive alternative to CABG given the comparable long-term mortality and lower incidences of stroke.
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Affiliation(s)
- Mahin R Khan
- Resident Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan
| | - Waleed T Kayani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | | | - Ravi S Hira
- University of Washington, Seattle, Washington
| | - Salim S Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Ihab Hamzeh
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Nasser Lakkis
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mahboob Alam
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.
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17
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Impact of previous drug-eluting stent restenosis in non-left main coronary artery lesions on long-term outcomes after left main coronary artery stenting: an observation from the AOI-LMCA registry. Cardiovasc Interv Ther 2017; 33:350-359. [PMID: 29052105 DOI: 10.1007/s12928-017-0497-2] [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: 07/02/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
We hypothesized that patients who had previous target-lesion revascularization (TLR) for DES restenosis in non-left main coronary artery (LMCA) lesions might have a higher risk for restenosis after subsequent DES implantation for a de novo unprotected LMCA lesion. Among 1809 patients enrolled in the Assessing Optimal Percutaneous Coronary Intervention for LMCA (AOI-LMCA) registry, which is a retrospective 6-centre registry of consecutive patients undergoing LMCA stenting in Japan, 251 patients with previous DES implantation for non-LMCA lesions were subdivided into the 2 groups with (N = 56) or without (N = 195) previous TLR in non-LMCA lesions. The risk for TLR for LMCA was neutral between the prior TLR for DES restenosis group and the no prior TLR for DES restenosis group [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.44-2.02, P = 0.98]. The risks for both TLR caused by restenosis of the LMCA main branch, and second TLR for restenosis after first TLR for LMCA were also neutral between the 2 groups (HR 0.42, 95% CI 0.10-1.25, P = 0.13, and HR 0.59, 95% CI 0.03-3.63, P = 0.60, respectively). In conclusion, prior TLR for DES restenosis in non-LMCA lesions was not associated with worse long-term clinical outcomes after DES implantation for de novo unprotected LMCA lesions. CLINICAL TRIAL REGISTRATION Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry (AOI LMCA Stenting Registry). http://www.umin.ac.jp/ctr/index/htm/ . Unique Identifier: UMIN000014706.
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Capodanno D, Gargiulo G, Buccheri S, Chieffo A, Meliga E, Latib A, Park SJ, Onuma Y, Capranzano P, Valgimigli M, Narbute I, Makkar RR, Palacios IF, Kim YH, Buszman PE, Chakravarty T, Sheiban I, Mehran R, Naber C, Margey R, Agnihotri A, Marra S, Leon MB, Moses JW, Fajadet J, Lefèvre T, Morice MC, Erglis A, Alfieri O, Serruys PW, Colombo A, Tamburino C. Computing Methods for Composite Clinical Endpoints in Unprotected Left Main Coronary Artery Revascularization: A Post Hoc Analysis of the DELTA Registry. JACC Cardiovasc Interv 2017; 9:2280-2288. [PMID: 27884354 DOI: 10.1016/j.jcin.2016.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/25/2016] [Accepted: 08/17/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study sought to investigate the impact of different computing methods for composite endpoints other than time-to-event (TTE) statistics in a large, multicenter registry of unprotected left main coronary artery (ULMCA) disease. BACKGROUND TTE statistics for composite outcome measures used in ULMCA studies consider only the first event, and all the contributory outcomes are handled as if of equal importance. METHODS The TTE, Andersen-Gill, win ratio (WR), competing risk, and weighted composite endpoint (WCE) computing methods were applied to ULMCA patients revascularized by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) at 14 international centers. RESULTS At a median follow-up of 1,295 days (interquartile range: 928 to 1,713 days), all analyses showed no difference in combinations of death, myocardial infarction, and cerebrovascular accident between PCI and CABG. When target vessel revascularization was incorporated in the composite endpoint, the TTE (p = 0.03), Andersen-Gill (p = 0.04), WR (p = 0.025), and competing risk (p < 0.001) computing methods showed CABG to be significantly superior to PCI in the analysis of 1,204 propensity-matched patients, whereas incorporating the clinical relevance of the component endpoints using WCE resulted in marked attenuation of the treatment effect of CABG, with loss of significance for the difference between revascularization strategies (p = 0.10). CONCLUSIONS In a large study of ULMCA revascularization, incorporating the clinical relevance of the individual outcomes resulted in sensibly different findings as compared with the conventional TTE approach. In particular, using the WCE computing method, PCI and CABG were no longer significantly different with respect to the composite of death, myocardial infarction, cerebrovascular accident, or target vessel revascularization at a median of 3 years.
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Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Giuseppe Gargiulo
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Buccheri
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Meliga
- Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto I, Turin, Italy
| | - Azeem Latib
- Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Seung-Jung Park
- Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Piera Capranzano
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Inga Narbute
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, and Institute of Cardiology, University of Latvia, Riga, Latvia
| | - Raj R Makkar
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Igor F Palacios
- Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Young-Hak Kim
- Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Pawel E Buszman
- Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland
| | - Tarun Chakravarty
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Imad Sheiban
- Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista Molinette Hospital, Turin, Italy
| | | | - Christoph Naber
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | - Ronan Margey
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Arvind Agnihotri
- Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sebastiano Marra
- Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista Molinette Hospital, Turin, Italy
| | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Thierry Lefèvre
- Hopital privé Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, and Institute of Cardiology, University of Latvia, Riga, Latvia
| | - Ottavio Alfieri
- Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Colombo
- Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Tamburino
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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Zheng Z, Xu B, Zhang H, Guan C, Xian Y, Zhao Y, Fan H, Yang Y, Wang W, Gao R, Hu S. Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Interventions in Patients With Unprotected Left Main Coronary Artery Disease. JACC Cardiovasc Interv 2017; 9:1102-11. [PMID: 27282597 DOI: 10.1016/j.jcin.2016.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study sought to investigate long-term clinical outcomes following coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with unprotected left main disease (ULMD). BACKGROUND PCI has been increasingly used as an alternative mode of revascularization for ULMD. However, there are limited data comparing clinical outcomes between CABG surgery and PCI. METHODS Between 2004 and 2010, 4,046 consecutive patients with ULMD were treated with either CABG surgery (n = 2,604) or PCI (n = 1,442) with drug-eluting stents. The primary outcome was 3-year all-cause mortality and the secondary outcome was the composite of death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS The unadjusted 3-year all-cause mortality was higher in the PCI group as compared with the CABG group (3.8% vs. 2.5%; log-rank p = 0.03), although there was no significant difference in the composite outcome (7.5% vs. 9.4%; log-rank p = 0.07). After adjustment for differences in baseline risk factors, PCI was associated with significantly higher risk of all-cause mortality (hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.32 to 2.21; p < 0.001) but similar risk of the composite outcome (HR: 0.94; 95% CI: 0.82 to 1.09; p = 0.43). These differences were not statistically significant among patients with low or intermediate SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (≤32) or diabetes; however, PCI was associated with an increased risk among those with high SYNTAX score (>32), with HRs of 3.10 (95% CI: 1.84 to 5.22; p < 0.001) for all-cause mortality and 1.82 (95% CI: 1.36 to 2.45; p < 0.001) for the composite outcome. CABG was associated with lower risk of repeat revascularization but higher risk of stroke in each clinically relevant subgroup. CONCLUSIONS In this single-center observational study among patients with ULMD, CABG was associated with improved long-term outcomes, especially in patients with more complex disease.
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Affiliation(s)
- Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xian
- Duke Clinical Research Institute, Durham, North Carolina
| | - Yanyan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyang Fan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Assessing the left main stem in the cardiac catheterization laboratory. What is "significant"? Function, imaging or both? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:51-56. [PMID: 28666791 DOI: 10.1016/j.carrev.2017.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
Revascularization of significant Left Main Stem (LMS) disease improves clinical outcomes. This can be achieved through either Coronary Artery Bypass Grafting or Percutaneous coronary intervention. Defining a significant stenosis of the LMS can be challenging and debatable, as most data have been derived using angiographic assessment alone, with a threshold of 50% luminal stenosis used as a marker of functional significance. The use of adjunctive technologies like Intravascular Ultrasound and Fractional Flow Reserve has improved our ability to accurately assess the anatomical severity and physiological significance of coronary artery stenoses, much more so, than can be achieved through conventional angiography alone. An improved assessment of LMS disease through these adjunctive techniques offers procedural and clinical benefits. Rather than focus on the preferred methods of revascularisation, this article aims to highlight the common pitfalls and misconceptions in the assessment of LMS stenoses. We also propose a simple algorithm for the assessment of LMS disease to help guide revascularisation decisions.
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Sardar P, Giri J, Elmariah S, Chatterjee S, Kolte D, Kundu A, Nairooz R, Aronow WS, Owan T, Mukherjee D, Feldman DN, Abbott JD. Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing. Am J Cardiol 2017; 119:1746-1752. [PMID: 28400029 DOI: 10.1016/j.amjcard.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are increasingly treated with percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES); however, the benefits of DES compared with coronary artery bypass grafting (CABG) in ULMCA remain controversial. This meta-analysis evaluated the effects of PCI with DES compared with CABG for the treatment of ULMCA stenosis. Databases were searched through November 30, 2016. Randomized controlled trials (RCTs) comparing DES with PCI versus CABG for ULMCA stenosis were identified. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome was major adverse cardiovascular events, defined as a composite of death from any cause, stroke, or myocardial infarction (MI). The analysis included 4,612 patients from 5 RCTs. Compared with CABG, patients assigned to PCI had a similar rate of major adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03, 95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR 1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was significantly greater in the PCI group than that in the CABG group (OR 1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs suggest that PCI with DES results in comparable mortality, stroke, and MI compared with CABG for revascularization of ULMCA stenosis, with PCI associated with higher rates of repeat revascularization.
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Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saurav Chatterjee
- Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Dhaval Kolte
- Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
| | - Amartya Kundu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ramez Nairooz
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Wilbert S Aronow
- Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, New York
| | - Theophilus Owan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - J Dawn Abbott
- Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
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Lemmert ME, Oldroyd K, Barragan P, Lesiak M, Byrne RA, Merkulov E, Daemen J, Onuma Y, Witberg K, van Geuns RJ. Reduced duration of dual antiplatelet therapy using an improved drug-eluting stent for percutaneous coronary intervention of the left main artery in a real-world, all-comer population: Rationale and study design of the prospective randomized multicenter IDEAL-LM trial. Am Heart J 2017; 187:104-111. [PMID: 28454794 DOI: 10.1016/j.ahj.2017.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous improvements in stent technology make percutaneous coronary intervention (PCI) a potential alternative to surgery in selected patients with unprotected left main coronary artery (uLMCA) disease. The optimal duration of dual antiplatelet therapy (DAPT) in these patients remains undetermined, and in addition, new stent designs using a bioabsorbable polymer might allow shorter duration of DAPT. STUDY DESIGN IDEAL-LM is a prospective, randomized, multicenter study that will enroll 818 patients undergoing uLMCA PCI. Patients will be randomized in a 1:1 fashion to intravascular ultrasound-guided PCI with the novel everolimus-eluting platinum-chromium Synergy stent with a biodegradable polymer (Boston Scientific, Natick, MA) followed by 4 months of DAPT or the everolimus-eluting cobalt-chromium Xience stent (Abbott Vascular, Santa Clara, CA) followed by 12 months of DAPT. The total follow-up period will be 5 years. A subset of 100 patients will undergo optical coherence tomography at 3 months. END POINTS The primary end point will be major adverse cardiovascular events (composite of all-cause mortality, myocardial infarction, and ischemia-driven target vessel revascularization) at 2 years. Secondary end points will consist of the individual components of the primary end point, procedural success, a device-oriented composite end point, stent thrombosis as per Academic Research Consortium criteria, and bleeding as per Bleeding Academic Research Consortium criteria. SUMMARY IDEAL-LM is designed to assess the safety and efficacy of the novel Synergy stent followed by 4 months of DAPT vs the Xience stent followed by 12 months of DAPT in patients undergoing uLMCA PCI. The study will provide novel insights regarding optimal treatment strategy for patients undergoing PCI of uLMCA disease (www.clinicaltrials.gov, NCT 02303717).
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Long-Term Outcomes of Stenting the Proximal Left Anterior Descending Artery in the PROTECT Trial. JACC Cardiovasc Interv 2017; 10:548-556. [DOI: 10.1016/j.jcin.2016.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022]
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Naqvi SY, Klein J, Saha T, McCormick DJ, Goldberg S. Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease. Am J Cardiol 2017; 119:520-527. [PMID: 28012553 DOI: 10.1016/j.amjcard.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Abstract
Coronary artery bypass grafting (CABG) decreases mortality in patients with significant left main (LM) coronary artery disease and for years remained the therapy of choice for patients with this ominous lesion. Advances in percutaneous coronary intervention (PCI) have enabled it to become an alternative to CABG. The results of observational registries and randomized comparisons have shown the safety and efficacy of PCI in appropriately selected patients with low or intermediate angiographic risk scores. Furthermore, the use of physiological measures of flow limitation and the use of intracoronary imaging techniques has added benefit and improved outcomes. The use of fractional flow reserve to more accurately evaluate the significance of intermediate lesions and guide the extent of revascularization has been an important refinement. Intravascular ultrasound and optical coherence tomography assessment of optimal stent deployment has led to reductions in restenosis. Newer generation stents, combined with improvements in specific techniques, especially at the LM bifurcation have extended PCI to more complex anatomic scenarios. The availability of left ventricular support devices in patients with complex coronary anatomy and severely depressed left ventricular function has added a margin of safety to LM and multivessel intervention. Randomized comparisons of CABG with PCI in carefully selected patients, using contemporaneous surgical and interventional techniques and optimal medical therapy, will further aid heart teams in the decision-making process. In conclusion, this review will give a concise overview of the management of unprotected LM disease.
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Papadopoulos K, Lekakis I, Nicolaides E. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for patients with multivessel and unprotected left main coronary artery disease. SAGE Open Med 2017; 5:2050312116687707. [PMID: 28228950 PMCID: PMC5308424 DOI: 10.1177/2050312116687707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of percutaneous coronary intervention using second-generation drug-eluting stents with those of coronary artery bypass grafting among patients with multivessel disease and/or unprotected left main coronary artery disease in terms of mortality, myocardial infarction, repeat revascularization, and angina. BACKGROUND Although coronary artery disease is a leading cause of death in the Western world and in many developing countries, its optimal treatment is still a matter of controversy. Several studies have examined the clinical safety and efficacy of percutaneous coronary intervention using first-generation drug-eluting stents over coronary artery bypass grafting in patients with multivessel disease and/or unprotected left main coronary artery disease. However, this study compared the efficacy of percutaneous coronary intervention using second-generation drug-eluting stents to that of coronary artery bypass grafting for multivessel disease and/or unprotected left main coronary artery disease. METHODS This was a prospective single-center cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital. In total, 140 patients (94% men and 6% women) with chronic coronary artery disease undergoing revascularization with either percutaneous coronary intervention using second-generation drug-eluting stents or coronary artery bypass grafting were evaluated. We examined the differences in clinical outcomes between coronary artery bypass grafting and percutaneous coronary intervention at 1-year follow-up. RESULTS Percutaneous coronary intervention with second-generation drug-eluting stents as opposed to coronary artery bypass grafting resulted in similar rates of mortality (5.7% vs 11.4%, respectively; p = 0.135), myocardial infarction (0% vs 4.3%, respectively), repeat revascularization (4.3% vs 8.6%, respectively; p = 0.115) and angina (10% vs 18.6%, respectively; p = 0.153). CONCLUSION In this patient population, percutaneous coronary intervention with second-generation drug-eluting stents was not inferior to coronary artery bypass grafting in terms of mortality, myocardial infarction, repeat revascularization, or angina.
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Affiliation(s)
| | - Ioannis Lekakis
- Cardiology Department, Attikon University Hospital, Athens, Greece
| | - Evagoras Nicolaides
- Saint George’s Medical School, University of Nicosia Medical School, Nicosia, Cyprus
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Buchanan GL, Chieffo A, Colombo A. Percutaneous Coronary Intervention in Unprotected Left Main. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gill Louise Buchanan
- Department of Cardiology; North Cumbria University NHS Trust; Carlisle United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit; San Raffaele Scientific Hospital; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit; San Raffaele Scientific Hospital; Milan Italy
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Impact of chronic kidney disease on patients with unprotected left main coronary artery disease treated with coronary artery bypass grafting or drug-eluting stents. Coron Artery Dis 2016; 27:535-42. [DOI: 10.1097/mca.0000000000000396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sukul D, Seth M, Dixon SR, Zainea M, Slocum NK, Pielsticker EJ, Gurm HS. Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization. Catheter Cardiovasc Interv 2016; 90:94-101. [DOI: 10.1002/ccd.26781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Simon R. Dixon
- Division of Cardiology, Department of Medicine; Beaumont Hospital; Royal Oak Michigan
| | | | | | | | - Hitinder S. Gurm
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
- Veterans Affairs Medical Center; Ann Arbor Michigan
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Cavalcante R, Sotomi Y, Lee CW, Ahn JM, Farooq V, Tateishi H, Tenekecioglu E, Zeng Y, Suwannasom P, Collet C, Albuquerque FN, Onuma Y, Park SJ, Serruys PW. Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease. J Am Coll Cardiol 2016; 68:999-1009. [DOI: 10.1016/j.jacc.2016.06.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 01/13/2023]
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Yu XP, Wu CY, Ren XJ, Yuan F, Song XT, Luo YW, He JQ, Gao YC, Huang FJ, Gu CX, Sun LZ, Lyu SZ, Chen F. Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease. Chin Med J (Engl) 2016; 129:763-70. [PMID: 26996469 PMCID: PMC4819294 DOI: 10.4103/0366-6999.178968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. METHODS All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. RESULTS Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. CONCLUSIONS During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.
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Affiliation(s)
- Xian-Peng Yu
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chang-Yan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xue-Jun Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fei Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ya-Wei Luo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ji-Qiang He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue-Chun Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fang-Jiong Huang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Cheng-Xiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li-Zhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shu-Zheng Lyu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fang Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Abstract
Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.
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Affiliation(s)
- Neil Ruparelia
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK
| | - Alaide Chieffo
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
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Therapeutic effect of interventional therapy for unprotected left main coronary artery lesions in aged patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:634-40. [PMID: 26788040 PMCID: PMC4712369 DOI: 10.11909/j.issn.1671-5411.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To assesse the therapeutic effect of interventional therapy in aged patients with unprotected left main coronary artery (UPLM) lesions. Methods A total of 61 patients who were over 60 years and accepted interventional therapy of UPLM from January 2012 to November 2013 in our hospital were followed up for average 14.6 months by telephone call or outpatient visits. We analyzed the clinical features data of the interventional therapy and assessed the factors that likely influenced the clinical prognosis. Results The average age of the 61 patients was 73.9 years. The average left ventricular ejection fraction (LVEF) was 47.7%. The median of the estimated glomerular filtration rate (eGFR) was 52 mL/min per 1.73 mm2. The average SYNTAX score was 27.4 and the median of stent length was 36 mm. The cumulative incidence of cardiac death at 30 days and major adverse cardiac events (MACE) after one year was 6.6% and 32.5% estimated by Kaplan-Meier plots respectively. No severe hemorrhagic complications were observed during follow-up period. On multivariate regression analysis with a COX proportional hazards model, LVEF was an independent predictor of cardiac death at 30 days [Hazard ratio (HR): 0.7, P = 0.01]. As for MACE after one year, LVEF and eGFR were both independent predictors (HR: 0.91, P = 0.06 for LVEF, HR: 0.03, P = 0.097 for eGFR). Conclusions The interventional therapy for UPLM was effective and safe in aged patients. LVEF was the only predictor of cardiac death at 30 days, while LVEF and eGFR were both independent predictors of MACE after one year.
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Wei Z, Xie J, Wang K, Kang L, Dai Q, Bai J, Xu B. Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Aged Patients With Unprotected Left Main Artery Lesions. Int Heart J 2016; 57:682-688. [DOI: 10.1536/ihj.15-420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Zhonghai Wei
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Jun Xie
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Kun Wang
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Lina Kang
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Qing Dai
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Jian Bai
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Biao Xu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
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Gargiulo G, Tamburino C, Capodanno D. Five-year outcomes of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with left main coronary artery disease: An updated meta-analysis of randomized trials and adjusted observational studies. Int J Cardiol 2015; 195:79-81. [PMID: 26025863 DOI: 10.1016/j.ijcard.2015.05.136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Giuseppe Gargiulo
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
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Naito R, Miyauchi K. Is an appropriate revascularization selected for unprotected left main coronary artery disease? Circ J 2015; 79:1201-3. [PMID: 25959435 DOI: 10.1253/circj.cj-15-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryo Naito
- Department of Cardiology, Juntendo University School of Medicine
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36
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Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease. J Am Coll Cardiol 2015; 65:2198-206. [DOI: 10.1016/j.jacc.2015.03.033] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/21/2022]
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Gao F, Zhou YJ, Wang ZJ, Yan ZX, Liu XL, Shen H. Transradial Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main and/or Multivessel Disease in Patients With Acute Coronary Syndrome. Angiology 2015; 67:83-8. [PMID: 25818105 DOI: 10.1177/0003319715578066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The overall safety and efficacy of transradial coronary intervention (TRI) versus coronary artery bypass grafting (CABG) for patients with unprotected left main (UPLM) disease and/or multivessel coronary disease (MVD) presenting with acute coronary syndrome (ACS) have not been established. Consecutive patients with ACS undergoing TRI with drug-eluting stent (n = 1431) or CABG (n = 651) for UPLM and/or MVD were included. A propensity-score matching was performed to adjust for differences in baseline characteristics between the 2 cohorts, yielding 524 pairs of matched patients. Median clinical follow-up was 32 months. After propensity-score adjustment, no significant difference was observed between the TRI and CABG groups in all-cause mortality (4.0% vs 5.2%; P = .375). Transradial coronary intervention was favored by a significant increase in the incidence of stroke in the CABG group (0.4% vs 1.9%; P = .020), whereas a significantly increased target vessel revascularization rate (16.8% vs 6.3%; P < .0001) observed in the TRI group favored CABG. Composite outcome (death/myocardial infarction/stroke) was comparable between the TRI and the CABG groups (8.0% vs 11.5%; P = .061). Clinical outcomes of TRI on UPLM and/or MVD for patients with ACS are comparable to CABG in composite safety outcomes with the advantage to TRI for avoiding a stroke.
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Affiliation(s)
- Fei Gao
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yu Jie Zhou
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
| | - Zhi Jian Wang
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
| | - Zhen Xian Yan
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Li Liu
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
| | - Hua Shen
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China
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Passeri JJ, Melnitchouk S, Palacios IF, Sundt TM. Continued expansion of the Heart Team concept. Future Cardiol 2015; 11:219-28. [DOI: 10.2217/fca.15.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The concept of a multidisciplinary Heart Team approach to treating cardiovascular disease has garnered increasing interest in recent years. This team-based approach has been a cornerstone of practice in other medical fields, such as oncology and solid organ transplantation. Advances in technology and new therapeutic strategies now offer multiple treatment options to patients with complex coronary artery or valvular heart disease, making therapeutic decision-making more challenging. There is a growing literature that use of a Heart Team for management of these complex cardiovascular diseases has demonstrated great merit. While the composition and implementation of Heart Team will vary, this multidisciplinary team-based approach will become the standard of care in cardiovascular medicine in the future.
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Affiliation(s)
- Jonathan J Passeri
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital & Harvard Medical School, Yawkey Building, Suite 5700, Boston, MA 02114, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Igor F Palacios
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital & Harvard Medical School, Yawkey Building, Suite 5700, Boston, MA 02114, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol 2015; 22:162-215. [PMID: 25523415 DOI: 10.1007/s12350-014-0025-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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40
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Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Sakata R, Okabayashi H, Hanyu M, Shimamoto M, Nishiwaki N, Komiya T, Kimura T. Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease – 5-Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort-2 –. Circ J 2015; 79:1282-9. [DOI: 10.1253/circj.cj-15-0034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
| | | | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Michiya Hanyu
- Division of Cardiovascular Surgery, Kokura Memorial Hospital
| | | | - Noboru Nishiwaki
- Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014; 64:e77-137. [PMID: 25091544 DOI: 10.1016/j.jacc.2014.07.944] [Citation(s) in RCA: 813] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sibbald M, Chan W, Daly P, Horlick E, Ing D, Ivanov J, Mackie K, Osten MD, Overgaard CB, Džavík V. Long-term outcome of unprotected left main stenting: a Canadian tertiary care experience. Can J Cardiol 2014; 30:1407-14. [PMID: 25442439 DOI: 10.1016/j.cjca.2014.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/09/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Coronary stenting is increasingly used to treat unprotected left main disease in selected patients. However, there is a paucity of data on the long-term outcome of these patients in a Canadian context outside of clinical trials. METHODS We retrospectively reviewed all provincially-insured patients undergoing left main coronary stenting at a large tertiary referral centre from 2000-2011. Pre-procedural angiograms were reviewed to identify the location of left main disease, and extent of concomitant coronary disease quantified by calculating Synergy Between Percutaneous Coronary Intervention With TAXUS Drug-Eluting Stent and Cardiac Surgery (SYNTAX) scores for each patient. In-hospital death and major adverse cardiac event (MACE) rates were evaluated as were long-term death and MACE rates obtained via linkage of our institutional registry with the Ontario health claims database. RESULTS Two hundred twenty-one patients underwent unprotected left main stenting with 29 (13.1%) in-hospital death and 34 (15.4%) a MACE. At an average follow-up of 3.1 ± 2.8 years, 109 patients (49.3%) died and 151 (68.3%) experienced a MACE. Higher SYNTAX tertile and use of bare metal rather than drug-eluting stents was associated with increased rates of in-hospital and long-term death. CONCLUSIONS This study reports, to our knowledge, the largest Canadian cohort of unprotected left main stenting over more than a decade. Coronary stenting was associated with acceptable in-hospital event rates, but poor long-term outcomes, reflecting the higher-risk population traditionally selected for this procedure.
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Affiliation(s)
- Matthew Sibbald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - William Chan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Paul Daly
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Eric Horlick
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Ing
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Ivanov
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Karen Mackie
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark D Osten
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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43
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2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.945] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Abstract
Though coronary bypass graft surgery (CABG) has traditionally been the cornerstone of therapy in patients with unprotected left main coronary artery (ULMCA) disease, recent evidence supports the use of percutaneous coronary intervention in appropriate patients. Indeed in patients with ULMCA disease, drug-eluting stents (DES) have shown similar incidence of hard end points, fewer periprocedural complications and lower stroke rates compared with CABG, though at the cost of increased revascularization with time. Furthermore, the availability of newer efficacious and safer DES as well as improvements in diagnostic tools, percutaneous techniques and, importantly, a better patient selection, allowed percutaneous coronary intervention a viable alternative to CABG of left main-patients with low disease complexity; however, even in this interventional era characterized by efficacious DES, patients with ULMCA disease remain a challenging high-risk population where outcomes strongly depend on clinical characteristics, anatomical disease complexity and extension and operator's experience. This review summarizes the role of DES in ULMCA disease patients.
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Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
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Higami H, Shiomi H, Niki S, Tazaki J, Imai M, Saito N, Makiyama T, Shizuta S, Shioi T, Ono K, Kimura T. Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease. Cardiovasc Interv Ther 2014; 30:189-97. [DOI: 10.1007/s12928-014-0297-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/22/2014] [Indexed: 11/30/2022]
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Naganuma T, Chieffo A, Takagi K, Panoulas VF, Mitomo S, Sticchi A, Latib A, Miyazaki T, Sato K, Costopoulos C, Fujino Y, Montorfano M, Carlino M, Nakamura S, Colombo A. First generation versus new generation drug-eluting stents for the treatment of ostial/midshaft lesions in unprotected left main coronary artery: The Milan and New-Tokyo (MITO) registry. Catheter Cardiovasc Interv 2014; 85:E63-9. [DOI: 10.1002/ccd.25624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/02/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Toru Naganuma
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Alaide Chieffo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Kensuke Takagi
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Vasileios F. Panoulas
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
- Imperial College London; National Heart and Lung Institute; London United Kingdom
| | - Satoru Mitomo
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Alessandro Sticchi
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Azeem Latib
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Tadashi Miyazaki
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Katsumasa Sato
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Charis Costopoulos
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Yusuke Fujino
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Matteo Montorfano
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Mauro Carlino
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Sunao Nakamura
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Antonio Colombo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
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Mancini GJ, Gosselin G, Chow B, Kostuk W, Stone J, Yvorchuk KJ, Abramson BL, Cartier R, Huckell V, Tardif JC, Connelly K, Ducas J, Farkouh ME, Gupta M, Juneau M, O’Neill B, Raggi P, Teo K, Verma S, Zimmermann R. Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. Can J Cardiol 2014; 30:837-49. [DOI: 10.1016/j.cjca.2014.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215-45. [PMID: 25085962 DOI: 10.1161/cir.0000000000000105] [Citation(s) in RCA: 464] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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49
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e278-333. [PMID: 25085961 DOI: 10.1161/cir.0000000000000106] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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50
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Roh JH, Kim YH, Ahn JM, Yun SH, Lee JB, Ge J, Le W, Park GM, Lee JY, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. Readmission rate after coronary artery bypass grafting versus percutaneous coronary intervention for unprotected left main coronary artery narrowing. Am J Cardiol 2014; 113:1639-46. [PMID: 24666619 DOI: 10.1016/j.amjcard.2014.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/26/2022]
Abstract
Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p <0.001). The most frequent causes of readmission were repeat revascularization after PCI (41%) and noncardiac readmissions after CABG (48%). Through repeated events analysis, PCI was associated with more frequent readmissions than CABG (hazard ratio 2.037, 95% confidence interval 1.542 to 2.692, p <0.001), being an independent predictor of readmission (hazard ratio 1.820, 95% confidence interval 1.420 to 2.331, p <0.001). Except for the acute period, defined as the first 3 months, when there was no significant difference in readmission rate, a higher readmission rate after PCI was consistently observed over the remainder of the follow-up period. In conclusion, PCI was shown to be associated with a higher risk of readmission than CABG in treating ULMCA disease. This higher risk was attributable to more frequent revascularization in the PCI group.
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