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Daoulah A, Alqahtani AH, Elmahrouk A, Yousif N, Almahmeed W, Arafat AA, Al Garni T, Qutub MA, Dahdouh Z, Alshehri M, Hersi AS, Malak MM, Djunaedi SR, Zaidi A, Naser MJ, Qenawi W, Elganady A, Hassan T, Ball V, Elmahrouk Y, Hussien AF, Alzahrani B, Abuelatta R, Selim E, Jamjoom A, Alshali KZ, Hashmani S, Refaat W, Kazim HM, Ghani MA, Amin H, Ibrahim AM, Abohasan A, Alama MN, Balghith M, Abdulhabeeb IAM, Ahmad O, Ramadan M, Ghonim AA, Shawky AM, Noor HA, Alqahtani AM, Al Samadi F, Abualnaja S, Baqais RT, Alhassoun A, Altnji I, Khan M, Alasmari A, Aljohar A, Hiremath N, Aithal J, Lotfi A. Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization. Eur J Med Res 2023; 28:210. [PMID: 37393361 DOI: 10.1186/s40001-023-01189-1] [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: 04/06/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease. METHODS This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Emergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10-37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14-0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23-6.08), P = 0.845]. CONCLUSIONS PCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia.
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Majed M Malak
- Department of Medicine, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia
| | - Syifa R Djunaedi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
| | - Ayesha Zaidi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
| | - Maryam Jameel Naser
- Department of Medicine, Baystate Medical Center, 759 Chestnut St, Springfield, MA, USA
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Vincent Ball
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Adnan Fathey Hussien
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
| | - Khalid Z Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Hameedullah M Kazim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abeer M Shawky
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Husam A Noor
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Abdulrahman M Alqahtani
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Al Samadi
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Seraj Abualnaja
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Rasha Taha Baqais
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdulkarim Alhassoun
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Issam Altnji
- Department of Cardiology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Mushira Khan
- Al Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, UAE
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
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