Se Hun Kang1, Jung-Min Ahn1, Cheol Hyun Lee1, Pil Hyung Lee1, Soo-Jin Kang1, Seung-Whan Lee1, Young-Hak Kim1, Cheol Whan Lee1, Seong-Wook Park1, Duk-Woo Park2, Seung-Jung Park1. 1. From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.). 2. From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.). dwpark@amc.seoul.kr.
Abstract
BACKGROUND: Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies. METHODS AND RESULTS: The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608). We analyzed the incidence and independent predictors of major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) and all-cause mortality in each treatment stratum. During follow-up (median, 4.3 years), the rates of MACCE and death were substantially higher in the medical group than in the percutaneous coronary intervention and coronary-artery bypass grafting groups (P<0.001). In the percutaneous coronary intervention group, the 3 strongest predictors for MACCE were chronic renal failure, old age (≥65 years), and previous heart failure; those for all-cause mortality were chronic renal failure, old age, and low ejection fraction. In the coronary-artery bypass grafting group, old age, chronic renal failure, and low ejection fraction were the 3 strongest predictors of MACCE and death. In the medication group, old age, low ejection fraction, and diabetes mellitus were the 3 strongest predictors of MACCE and death. CONCLUSIONS: Among patients with unprotected left main coronary artery disease, the key clinical predictors for MACCE and death were generally similar regardless of index treatment. This study provides effect estimates for clinically relevant predictors of long-term clinical outcomes in real-world left main coronary artery patients, providing possible guidance for tailored preventive strategies. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01341327.
BACKGROUND: Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies. METHODS AND RESULTS: The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608). We analyzed the incidence and independent predictors of major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) and all-cause mortality in each treatment stratum. During follow-up (median, 4.3 years), the rates of MACCE and death were substantially higher in the medical group than in the percutaneous coronary intervention and coronary-artery bypass grafting groups (P<0.001). In the percutaneous coronary intervention group, the 3 strongest predictors for MACCE were chronic renal failure, old age (≥65 years), and previous heart failure; those for all-cause mortality were chronic renal failure, old age, and low ejection fraction. In the coronary-artery bypass grafting group, old age, chronic renal failure, and low ejection fraction were the 3 strongest predictors of MACCE and death. In the medication group, old age, low ejection fraction, and diabetes mellitus were the 3 strongest predictors of MACCE and death. CONCLUSIONS: Among patients with unprotected left main coronary artery disease, the key clinical predictors for MACCE and death were generally similar regardless of index treatment. This study provides effect estimates for clinically relevant predictors of long-term clinical outcomes in real-world left main coronary arterypatients, providing possible guidance for tailored preventive strategies. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01341327.
Authors: Raffaele Piccolo; Kaare H Bonaa; Orestis Efthimiou; Olivier Varenne; Philip Urban; Christoph Kaiser; Lorenz Räber; Adam de Belder; Wouter Remkes; Arnoud W J Van't Hof; Goran Stankovic; Pedro A Lemos; Tom Wilsgaard; Jörg Reifart; Alfredo E Rodriguez; Expedito E Ribeiro; Patrick W J C Serruys; Alex Abizaid; Manel Sabaté; Robert A Byrne; Jose M de la Torre Hernandez; William Wijns; Giovanni Esposito; Peter Jüni; Stephan Windecker; Marco Valgimigli Journal: J Am Heart Assoc Date: 2021-10-08 Impact factor: 5.501