Rafael Cavalcante1, Yohei Sotomi2, Cheol W Lee3, Jung-Min Ahn3, Vasim Farooq4, Hiroki Tateishi5, Erhan Tenekecioglu5, Yaping Zeng5, Pannipa Suwannasom2, Carlos Collet2, Felipe N Albuquerque5, Yoshinobu Onuma5, Seung-Jung Park3, Patrick W Serruys6. 1. Thoraxcenter, Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. 2. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 4. Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom. 5. Thoraxcenter, Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. 6. International Center for Circulatory Health, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Abstract
BACKGROUND: Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES: This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS: We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. RESULTS:Study population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. CONCLUSIONS: In patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM + 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG.
RCT Entities:
BACKGROUND: Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES: This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS: We conducted a pooled analysis of individual patient-level data of the LMDpatients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. RESULTS: Study population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. CONCLUSIONS: In patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM + 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG.
Authors: Harsha S Nagarajarao; Chandra P Ojha; Venkatachalam Mulukutla; Ahmed Ibrahim; Adriana C Mares; Timir K Paul Journal: Curr Cardiol Rep Date: 2020-02-08 Impact factor: 2.931
Authors: Javier A Valle; Hector Tamez; J Dawn Abbott; Issam D Moussa; John C Messenger; Stephen W Waldo; Kevin F Kennedy; Frederick A Masoudi; Robert W Yeh Journal: JAMA Cardiol Date: 2019-02-01 Impact factor: 14.676
Authors: Rafał Januszek; Artur Dziewierz; Zbigniew Siudak; Tomasz Rakowski; Tomasz Kameczura; Tomasz Tokarek; Dariusz Dudek; Stanisław Bartuś Journal: Arch Med Sci Date: 2019-06-22 Impact factor: 3.318