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Jonjev ŽS, Adam A, Kalinić N, Zdravković R, Mrvić S. Coronary artery bypass grafting versus percutaneous coronary intervention in single-vessel left anterior descending artery disease: mid-term propensity matching study. Indian J Thorac Cardiovasc Surg 2024; 40:311-317. [PMID: 38681724 PMCID: PMC11045704 DOI: 10.1007/s12055-023-01657-7] [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: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction Coronary artery bypass grafting (CABG) has been considered to be the proven therapeutic choice for coronary artery disease. However, percutaneous coronary intervention (PCI) with drug-eluting stents is increasingly used for extensive coronary artery disease with contradictory results. The aim of this study is to compare immediate- and mid-term results of CABG where skeletonized internal mammary artery (IMA) was used as in situ graft versus PCI with serolimus drug eluted stents (SES) in single-vessel left anterior descending artery (LAD) disease. Methods In 2014-2022, 938 patients treated for isolated LAD revascularization were included in this study. Among them, there were 346 patients with CABG-IMA and 592 patients with SES-PCI. CABG-IMA patients (n = 266) were compared with SES-PCI patients (n = 266) in propensity score-matched method.Primary outcome measures were identified as all-cause mortality at 30 days and 3 years after surgery, while secondary outcome measures were length of hospital stay and the incidence of postoperative major adverse cardiovascular and cerebrovascular events (MACCE). Results Increased incidence for post procedural MACCE after PCI was recorded (CABG = 1.2% vs. PCI = 5.3%; p < 0.05). There was no difference in immediate-term (30 days: CABG = 1.2% vs. PCI = 1.5%; p = ns) and mid-term (3 years: CABG = 3.7% vs. PCI = 4.5%; p = ns) mortality between the groups. Patient after SES-PCI had shorter length of hospital stay (CABG = 7.7 days vs. PCI = 3.8 days; p < 0.05). Conclusion The results of the study indicated that CABG-IMA performed at the time of myocardial revascularization in single-vessel LAD disease is better than SES-PCI. Our conclusion is independent of traditionally accepted risk factors incorporated in the Logistic EuroSCORE II (European System for Cardiac Operative Risk Evaluation) and SYNTAX score II (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Score II) and is exclusively method related.
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Affiliation(s)
- Živojin S. Jonjev
- Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia
- University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska Bosnia and Herzegovina
| | - Adam Adam
- John H. Stroger, Jr., Hospital of Cook County, Chicago, IL USA
| | - Novica Kalinić
- University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska Bosnia and Herzegovina
| | - Ranko Zdravković
- Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia
| | - Strahinja Mrvić
- Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia
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Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis 2021; 13:1922-1944. [PMID: 33841980 PMCID: PMC8024818 DOI: 10.21037/jtd-20-1535] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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Ji L, Liu C, Li P, Wang X, Liu C, Hou Y. Increased pulse wave transit time after percutaneous coronary intervention procedure in CAD patients. Sci Rep 2018; 8:115. [PMID: 29311630 PMCID: PMC5758522 DOI: 10.1038/s41598-017-18520-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
Abstract
Pulse wave transit time (PWTT) has been widely used as an index in assessing arterial stiffness. Percutaneous coronary intervention (PCI) is usually applied to the treatment of coronary artery disease (CAD). Research on the changes in PWTT caused by PCI is helpful for understanding the impact of the PCI procedure. In addition, effects of stent sites and access sites on the changes in PWTT have not been explored. Consequently, this study aimed to provide this information. The results showed that PWTT significantly increased after PCI (p < 0.01) while the standard deviation (SD) of PWTT time series had no statistically significant changes (p = 0.60) between before and after PCI. Significantly increased PWTT was found in the radial access group (p < 0.01), while there were no significant changes in the femoral access group (p > 0.4). Additionally, PWTT in the left anterior descending (LAD) group significantly increased after PCI (p < 0.01), but the increase that was found in the right coronary artery (RCA) group was not significant (p > 0.1). Our study indicates that arterial elasticity and left ventricular functions can benefit from a successful PCI procedure, and the increase of peripheral PWTT after PCI can help to better understand the effectiveness of the procedure.
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Affiliation(s)
- Lizhen Ji
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.,Institute of Environment and Ecology, College of Geography and Environment, Shandong Normal University, Jinan, 250014, China
| | - Chengyu Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Peng Li
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Xinpei Wang
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Changchun Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
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Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:285-290. [PMID: 29062450 PMCID: PMC5649490 DOI: 10.5114/wiitm.2017.67679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/14/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). Aim To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. Material and methods Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses. Results Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group. Conclusions We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.
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Hickey GL, Pullan M, Oo A, Mediratta N, Chalmers J, Bridgewater B, Poullis M. A comparison of survival between on-pump and off-pump left internal mammary artery bypass graft surgery for isolated left anterior descending coronary artery disease: an analysis of the UK National Adult Cardiac Surgery Audit Registry. Eur J Cardiothorac Surg 2015; 49:1441-9. [DOI: 10.1093/ejcts/ezv396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
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Harskamp RE, Williams JB, Halkos ME, Lopes RD, Tijssen JGP, Ferguson TB, de Winter RJ. Meta-analysis of minimally invasive coronary artery bypass versus drug-eluting stents for isolated left anterior descending coronary artery disease. J Thorac Cardiovasc Surg 2014; 148:1837-42. [PMID: 24755335 PMCID: PMC4322677 DOI: 10.1016/j.jtcvs.2014.03.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 02/10/2014] [Accepted: 03/13/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the outcomes between minimally invasive coronary artery bypass (MINI-CAB) and drug-eluting stent (DES) implantation for isolated left anterior descending artery disease. METHODS Randomized and observational comparative publications were identified using MEDLINE and Google Scholar databases (January 2003 to December 2013). Studies without outcomes data, without DES use, or using conventional bypass surgery were excluded. The outcomes of interest were cardiac death, myocardial infarction, target vessel revascularization, and periprocedural stroke. Data were compared using the Mantel-Haenszel methods and are presented as odds ratios (ORs), 95% confidence intervals (CIs), and number needed to treat. RESULTS From 230 publications, we identified 4 studies (2 randomized and 2 observational) with 941 patients (478 had undergone MINI-CAB and 463 DES implantation). The incidence of target vessel revascularization at maximum follow-up (range, 6-60 months) was significantly lower in the MINI-CAB group (OR, 0.16; 95% CI, 0.08-0.30; P<.0001; number needed to treat, 13). The incidence of cardiac mortality and MI was similar between the MINI-CAB and DES groups during follow-up (OR, 1.05; 95% CI, 0.44-2.47; and OR, 0.83; 95% CI, 0.43-1.58, respectively). In addition, a similar incidence of periprocedural death (OR, 0.85; 95% CI, 0.21-3.47; P=.82), myocardial infarction (OR, 0.98; 95% CI, 0.38-2.58; P=.97), and stroke (OR, 1.36; 95% CI, 0.28-6.70; P=.70) was observed between the 2 treatment modalities. CONCLUSIONS Given the available evidence, MINI-CAB will result in lower target vessel revascularization rates but otherwise similar clinical outcomes compared with DESs in patients with left anterior descending artery disease.
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Affiliation(s)
- Ralf E Harskamp
- Duke Clinical Research Institute, Durham, NC; Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | | | - Jan G P Tijssen
- Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC
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Raffa GM, Malvindi PG, Ornaghi D, Citterio E, Cappai A, Basciu A, Barbone A, Fossati F, Tarelli G, Settepani F. Minimally invasive direct coronary artery bypass in the era of percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2013; 16:118-24. [PMID: 23877205 DOI: 10.2459/jcm.0b013e3283630c60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Minimally invasive coronary artery bypass (MIDCAB) allows revascularization of the left anterior descending coronary (LAD) artery through a less traumatic surgical approach. However, the procedure is technically challenging and concern still exists, mainly based on graft patency. The purpose of this study is to critically evaluate short and long-term benefits of this surgical treatment. METHODS Between June 1997 and July 2012, 306 patients underwent MIDCAB on LAD. The mean age was 62 ± 10 years (range, 32-87 years) and 264 patients (86.3%) were men. Mean ejection fraction was 54%. Eighty-nine procedures (29.1%) were performed using a hybrid approach by means of MIDCAB and postoperative (60 patients, 67.4%) or preoperative (29 patients, 32.6%) percutaneous interventions on non-LAD vessels. A EuroScore more than 6 was found in 43 (14%) patients. The average follow-up time was 9.5 ± 3.2 years and was 89% complete. RESULTS Six patients (1.9%) required intraoperative conversion to sternotomy, whereas cardiopulmonary bypass institution after the sternotomy was necessary in one. Postoperative acute myocardial infarction occurring nine patients (2.9%), low output syndrome in four (1.3%). Postoperative mortality was 1.6% (n = 5), and perioperative stroke rate 0.6% (n = 2). Five and 10-year survival were 94.1 and 86.9%, respectively. Freedom from death due to cardiac events and major cardiac and cerebral events at 10 years was, respectively, 97.1 and 92.1%. CONCLUSIONS The results confirm the favorable short and long-term results of the MIDCAB procedure. MIDCAB, in experienced centers, can represent an alternative treatment option for LAD disease.
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Affiliation(s)
- Giuseppe M Raffa
- Unit of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Alidoosti M, Salarifar M, Zeinali AMH, Kassaian SE, Dehkordi MR. Comparison of outcomes of percutaneous coronary intervention on proximal versus non-proximal left anterior descending coronary artery, proximal left circumflex, and proximal right coronary artery: a cross-sectional study. BMC Cardiovasc Disord 2007; 7:7. [PMID: 17335586 PMCID: PMC1831789 DOI: 10.1186/1471-2261-7-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 03/04/2007] [Indexed: 01/14/2023] Open
Abstract
Background Previous studies have shown that lesions in proximal left anterior descending coronary artery (LAD) may develop more restenosis after balloon angioplasty than lesions in other coronary segments. However, stenting seems to have reduced this gap. In this study, we compared outcomes of percutaneous coronary intervention (PCI) on proximal LAD versus proximal left circumflex (LCX) or right coronary artery (RCA) and proximal versus non-proximal LAD. Methods From 1737 patients undergoing PCI between March 2004 and 2005, those with cardiogenic shock, primary PCI, total occlusions, and multivessel or multi-lesion PCI were excluded. Baseline characteristics and in-hospital outcomes were compared in 408 patients with PCI on proximal LAD versus 133 patients with PCI on proximal LCX/RCA (study I) and 244 patients with PCI on non-proximal LAD (study II). From our study populations, 449 patients in study I and 549 patients in study II participated in complete follow-up programs, and long-term PCI outcomes were compared within these groups. The statistical methods included Chi-square or Fisher's exact test, student's t-test, stratification methods, multivariate logistic regression and Cox proportional hazards model. Results In the proximal LAD vs. proximal LCX/RCA groups, smoking and multivessel disease were less frequent and drug-eluting stents were used more often (p = 0.01, p < 0.001, and p < 0.001, respectively). Patients had longer and smaller-diameter stents (p = 0.009, p < 0.001, respectively). In the proximal vs. non-proximal LAD groups, multivessel disease was less frequent (p = 0.05). Patients had larger reference vessel diameters (p < 0.001) and were more frequently treated with stents, especially direct stenting technique (p < 0.001). Angiographic success rate was higher in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups (p = 0.004 and p = 0.05, respectively). In long-term follow-up, major adverse cardiac events showed no difference. After statistical adjustment for significant demographic, angiographic or procedural characteristics, long-term PCI outcomes were still similar in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups. Conclusion Despite the known worse prognosis of proximal LAD lesions, in the era of stenting, our long-term outcomes were similar in patients with PCI on proximal LAD versus proximal LCX/RCA and non-proximal LAD. Furthermore, we had better angiographic success rates in patients with PCI on proximal LAD.
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Affiliation(s)
- Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran. Jalal Al Ahmad and North Karegar Cross PO Box: 1411713138 Tehran, Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran. Jalal Al Ahmad and North Karegar Cross PO Box: 1411713138 Tehran, Iran
| | - Ali Mohammad Haji Zeinali
- Department of Interventional Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran. Jalal Al Ahmad and North Karegar Cross PO Box: 1411713138 Tehran, Iran
| | - Seyed Ebrahim Kassaian
- Department of Interventional Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran. Jalal Al Ahmad and North Karegar Cross PO Box: 1411713138 Tehran, Iran
| | - Maria Raissi Dehkordi
- Research Department, Tehran Heart Center, Medical Sciences/University of Tehran, Jalal Al Ahmad and North Karegar Cross. PO Box: 1411713138 Tehran, Iran
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Valencia J, Berenguer A, Mainar V, Bordes P, Gómez S, Tello A, López-Aranda MA, Caturla J. Two-year follow-up of sirolimus-eluting stents for the treatment of proximal left anterior descending coronary artery stenosis. J Interv Cardiol 2006; 19:126-34. [PMID: 16650240 DOI: 10.1111/j.1540-8183.2006.00119.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sirolimus-eluting stents (SES) have demonstrated low target vessel revascularizations and low incidence of angiographic restenosis in several clinical scenarios. The aim of the present study was to assess the efficacy and safety of SES for the treatment of proximal left anterior descending coronary artery (pLAD) lesions. METHODS Ninety-six patients with severe pLAD stenosis were enrolled. Angiographic and clinical follow-up were performed at 6 and 24 months, respectively. Death, myocardial infarction (MI), new target lesion revascularization (TLR), and target vessel failure (TVF) were registered. Clinical, angiographic, and procedural variables were analyzed to identify predictors of restenosis. RESULTS Mean clinical follow-up was 858+/-158 days (26.5+/-8.3 months). Angiographic procedural success was 100%. Angiographic follow-up showed 8.4% of binary restenosis without edge-restenosis phenomenon. Late loss was 0.15+/-0.65 mm; 15.6% of patients had an adverse cardiac event, with 1% of death, 5.2% of MI, 6.3% of TLR, and 9.4% of TVF. At 2 years, the probabilities of cumulative TVF- and TLR-free survival were 90.6% and 93.7%, respectively. Interestingly, no adverse cardiac events were registered between the first and second years. Female gender (OR 10.7 CI 95%[1.7-66.7]) and in-stent restenosis (OR 8.2, CI 95%[1.2-56.4]) were found as independent predictors of binary restenosis. Advanced chronic renal failure showed a strong trend toward worse outcome in terms of binary restenosis (P=0.063). CONCLUSIONS SES for the treatment of pLAD stenosis proved safe and effective in a long-term follow-up with low incidence of adverse cardiac events and restenosis. Female gender and in-stent restenosis were predictors of binary restenosis.
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Affiliation(s)
- José Valencia
- Laboratorio de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain.
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Versaci F, Gaspardone A, Tomai F, Proietti I, Ghini AS, Altamura L, Andò G, Crea F, Gioffrè PA, Chiariello L. A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery: five year clinical follow up. BRITISH HEART JOURNAL 2004; 90:672-5. [PMID: 15145877 PMCID: PMC1768258 DOI: 10.1136/hrt.2003.020826] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stent implantation for isolated stenosis of the proximal left anterior descending coronary artery (LAD) with preserved left ventricular function has been found to have a better clinical and angiographic outcome at one year than balloon angioplasty (PTCA). OBJECTIVE To establish whether those results are maintained at five year follow up. METHODS Patients were followed at least every six months. For those who died during follow up, data were obtained from medical records. MAIN OUTCOME MEASURES Freedom from death, non-fatal myocardial infarction, cerebrovascular accident, and repeated target lesion revascularisation. Secondary end points were revascularisation in a remote region and freedom from angina. RESULTS Follow up was complete in all patients. At five years, the primary end point was reached more often by patients randomised to stent implantation than to PTCA (80% v 53%; odds ratio (OR) 0.29 (95% confidence interval (CI) 0.13 to 0.69); p = 0.0034). In the PTCA group, 35% of patients underwent target lesion revascularisation v 15% in the stent group (OR 0.33, 95% CI 0.13 to 0.80; p = 0.014). There was a trend towards increased mortality in the PTCA group than in the stent group (17% v 7%; OR 0.36, 95% CI 0.10 to 1.21; p = 0.098). No significant differences were found between PTCA and stent groups for non-fatal myocardial infarction (8% v 5%; OR 0.58, 95% CI 0.13 to 2.54; p = 0.46) or cerebrovascular accident (2% v 0%). CONCLUSIONS In patients with isolated stenosis of the proximal LAD, a five year clinical follow up confirmed a better outcome in those treated with stenting than with PTCA.
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Affiliation(s)
- F Versaci
- Division of Cardiac Surgery, Università Tor Vergata, Rome, Italy.
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