Toru Naganuma1, Alaide Chieffo1, Emanuele Meliga2, Davide Capodanno3, Seung-Jung Park4, Yoshinobu Onuma5, Marco Valgimigli6, Sanda Jegere7, Raj R Makkar8, Igor F Palacios9, Charis Costopoulos1, Young-Hak Kim4, Piotr P Buszman10, Tarun Chakravarty8, Imad Sheiban11, Roxana Mehran12, Christoph Naber13, Ronan Margey9, Arvind Agnihotri9, Sebastiano Marra11, Piera Capranzano3, Martin B Leon14, Jeffrey W Moses14, Jean Fajadet13, Thierry Lefevre15, Marie-Claude Morice15, Andrejs Erglis7, Corrado Tamburino3, Ottavio Alfieri1, Patrick W Serruys5, Antonio Colombo16. 1. Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. 2. Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy. 3. Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. 4. Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 5. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. 6. Cardiovascular Institute, University of Ferrara, S. Anna Hospital, Ferrara, Italy. 7. Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia. 8. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 9. Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 10. Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland. 11. Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy. 12. Mount-Sinai Medical Center, New York, New York. 13. Clinique Pasteur, Toulouse, France. 14. Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York. 15. Institut Hospitalier Jacques Cartier, Générale de Santé Massy, Massy, France. 16. Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.
Abstract
OBJECTIVES: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). BACKGROUND: Data regarding outcomes in these patients are limited. METHODS: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. RESULTS: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). CONCLUSIONS: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.
OBJECTIVES: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). BACKGROUND: Data regarding outcomes in these patients are limited. METHODS: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. RESULTS: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). CONCLUSIONS: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.