Long-term outcomes of PCI vs. CABG for ostial/midshafl lesions in unprotected left main coronary artery

Background There are limited data on long-term （〉 5 years） outcomes of drug-eluting stent （DES） implantation compared with coro- nary artery bypass grafting （CABG） for ostial/rnidshaft left main coronary artery （LMCA） lesions. Methods Of the 259 consecutive pa- tients in Beijing Anzhen Hospital with ostial/midshaff LMCA lesions, 149 were treated with percutaneous coronary intervention （PCI） with DES and 110 were with CABG. The endpoints of the study were death, repeat revascularization, myocardial infarction （MI）, stroke, the composite of cardiac death, and major adverse cardiac and cerebrovascular events （MACCE, the composite of cardiac death, MI, stroke or repeat revascularization）.The duration of follow-up is 7.1 years （interquartile range 5.3 to 8.2 years）. Results There is no significant differ- ence between the PCI and CABG group during the median follow-up of 7.1 years （interquartile range： 5.3-8.2 years） in the occurrence of death （HR： 0.727, 95% CI： 0.335-1.578; P = 0.421）, the composite endpoint of cardiac death, MI or stroke （HR： 0.730, 95% CI： 0.375-1.421; P = 0.354）, MACCE （HR： 1.066, 95% CI： 0.648-1.753; P = 0.801）, MI （HR： 1.112, 95% CI： 0.414-2.987; P = 0.833）, stroke （HR： 1.875, 95% CI： 0.528-6.659; P = 0.331）, and repeat revascularization （HR： 1.590, 95% CI： 0.800-3.161; P = 0.186）. These results remained after multivariable adjusting. Conclusion During a follow-up up to 8.2 years, we found that DES implantation had similar endpoint outcomes compared with CABG.

Twelve-year outcomes after revascularization for ostial/shaft lesions in unprotected left main coronary artery

Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting(CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled, who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The major endpoints of this study were death, repeat revascularization, non-procedural myocardial infarction(MI) and stroke. The median follow-up was twelve years(interquartile range: 9.4–14.0 years) in the overall patients. There were no significant differences of incidence of death(23.3% vs. 25.6%, P = 0.227), repeat revascularization(27.3% vs. 28.4%, P = 0.423), non-procedural MI(20.0% vs. 14.5%, P = 0.561), and stroke(6.1% vs. 9.3%, P = 0.255) between PCI and CABG groups before multivariate adjusting. After adjusting covariates with multivariate Cox hazard regression model, there were still no significant differences between PCI and CABG groups. Conclusions During the median follow-up of twelve years, we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.

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

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）. PC/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 = 0.03 l） 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.

Impact of prior cerebrovascular events on patients with unprotected left main coronary artery disease treated with coronary artery bypass grafting or percutaneous coronary intervention

Treatment of unprotected left main coronary artery(ULMCA)disease with coronary artery bypass grafting(CABG)or percutaneous coronary intervention(PCI)has developed rapidly during the past decades.The optimal revascularization strategy has been a subject of debate,with several randomized controlled trials and metaanalyses comparing outcomes of CABG and PCI.