Seung-Jung Park1, Jung-Min Ahn2, Young-Hak Kim2, Duk-Woo Park2, Sung-Cheol Yun2, Sung-Han Yoon2, Hyun Woo Park2, Mineok Chang2, Jong-Young Lee2, Soo-Jin Kang2, Seung-Whan Lee2, Cheol Whan Lee2, Seong-Wook Park2. 1. From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. sjpark@amc.seoul.kr. 2. From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., S.-H.Y., H.W.P., M.C., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Abstract
BACKGROUND: Changes over time in revascularization strategies and outcomes among patients with unprotected left main coronary artery stenosis remain largely unknown. METHODS AND RESULTS: A total of 2618 consecutive patients with unprotected left main coronary artery stenosis who underwent revascularization were identified from the ASAN Medical Center-Left MAIN Revascularization registry and classified by time periods: bare metal stent (wave 1, 1995-1998), early drug-eluting stents (wave 2, 2003-2006), and late drug-eluting stents (wave 3, 2007-2010). Primary end point was major adverse cerebrocardiovascular events (the composite of death, myocardial infarction, repeat revascularization, and stroke). During the study period, 1124 patients underwent percutaneous coronary intervention (PCI) and 1494 patients underwent coronary artery bypass grafting. The proportion of PCI significantly increased from 35% to 52% between waves 1 and 3. In patients receiving PCI, the risk-adjusted incidence rate of major adverse cerebro-cardiovascular events decreased from 20.18 cases per 100 person-years in wave 1 to 6.77 cases per 100 person-years in wave 3 (P<0.001 for trend). Death, the composite of death, myocardial infarction, stroke, and repeat revascularization were also significantly decreased by 40%, 35%, and 46%, respectively. The risk-adjusted incidence rate of major adverse cerebrocardiovascular events did not change in patients receiving coronary artery bypass grafting. The difference major adverse cerebrocardiovascular events risk between PCI and coronary artery bypass grafting progressively reduced (adjusted hazard ratio [95% confidence interval], 0.33 [0.23-0.47]; 0.53 [0.35-0.80]; and 1.01 [0.68-1.49] from wave 1 to wave 3. CONCLUSIONS: The outcomes of unprotected left main coronary artery PCI have significantly improved over time. In addition, more patients received PCI for unprotected left main coronary artery stenosis in recent years.
BACKGROUND: Changes over time in revascularization strategies and outcomes among patients with unprotected left main coronary artery stenosis remain largely unknown. METHODS AND RESULTS: A total of 2618 consecutive patients with unprotected left main coronary artery stenosis who underwent revascularization were identified from the ASAN Medical Center-Left MAIN Revascularization registry and classified by time periods: bare metal stent (wave 1, 1995-1998), early drug-eluting stents (wave 2, 2003-2006), and late drug-eluting stents (wave 3, 2007-2010). Primary end point was major adverse cerebrocardiovascular events (the composite of death, myocardial infarction, repeat revascularization, and stroke). During the study period, 1124 patients underwent percutaneous coronary intervention (PCI) and 1494 patients underwent coronary artery bypass grafting. The proportion of PCI significantly increased from 35% to 52% between waves 1 and 3. In patients receiving PCI, the risk-adjusted incidence rate of major adverse cerebro-cardiovascular events decreased from 20.18 cases per 100 person-years in wave 1 to 6.77 cases per 100 person-years in wave 3 (P<0.001 for trend). Death, the composite of death, myocardial infarction, stroke, and repeat revascularization were also significantly decreased by 40%, 35%, and 46%, respectively. The risk-adjusted incidence rate of major adverse cerebrocardiovascular events did not change in patients receiving coronary artery bypass grafting. The difference major adverse cerebrocardiovascular events risk between PCI and coronary artery bypass grafting progressively reduced (adjusted hazard ratio [95% confidence interval], 0.33 [0.23-0.47]; 0.53 [0.35-0.80]; and 1.01 [0.68-1.49] from wave 1 to wave 3. CONCLUSIONS: The outcomes of unprotected left main coronary artery PCI have significantly improved over time. In addition, more patients received PCI for unprotected left main coronary artery stenosis in recent years.
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