AIMS: A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. METHODS AND RESULTS: Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial's subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI 0.47-0.84 for values ≥ 33) while was not evident for 'younger' patients (OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older' patients). CONCLUSION: For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score. Published on behalf of the European Society of Cardiology.
AIMS: A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. METHODS AND RESULTS: Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial's subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI 0.47-0.84 for values ≥ 33) while was not evident for 'younger' patients (OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older' patients). CONCLUSION: For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score. Published on behalf of the European Society of Cardiology.
Entities:
Keywords:
Coronary artery bypass graft; Coronary artery disease; Meta-analysis; Percutaneous coronary intervention; Unprotected left main
Authors: Ganesh Athappan; Eshan Patvardhan; Murat E Tuzcu; Stephen Ellis; Patrick Whitlow; Samir R Kapadia Journal: JACC Cardiovasc Interv Date: 2013-12 Impact factor: 11.195
Authors: Franz-Josef Neumann; Miguel Sousa-Uva; Anders Ahlsson; Fernando Alfonso; Adrian P Banning; Umberto Benedetto; Robert A Byrne; Jean-Philippe Collet; Volkmar Falk; Stuart J Head; Peter Jüni; Adnan Kastrati; Akos Koller; Steen D Kristensen; Josef Niebauer; Dimitrios J Richter; Petar M Seferovic; Dirk Sibbing; Giulio G Stefanini; Stephan Windecker; Rashmi Yadav; Michael O Zembala Journal: Eur Heart J Date: 2019-01-07 Impact factor: 29.983
Authors: Marc P Bonaca; Robert F Storey; Pierre Theroux; P Gabriel Steg; Deepak L Bhatt; Marc C Cohen; KyungAh Im; Sabina A Murphy; Giulia Magnani; Ton Oude Ophuis; Mikhail Rudah; Alexander Parkhomenko; Daniel Isaza; Gabriel Kamensky; Assen Goudev; Gilles Montalescot; Eva C Jensen; Per Johanson; Eugene Braunwald; Marc S Sabatine Journal: J Am Coll Cardiol Date: 2017-09-12 Impact factor: 24.094
Authors: Umberto Barbero; Fabrizio D'Ascenzo; Gianluca Campo; Paweł Kleczyński; Artur Dziewierz; Mila Menozzi; Victor A Jiménez Díaz; Enrico Cerrato; Sergio Raposeiras-Roubín; Alfonso Ielasi; Andrea Rognoni; Massimo Fineschi; Rahim Kanji; Milosz J Jaguszewski; Andrea Picchi; Giuseppe Andò; Emmanuele Soraci; Massimo Mancone; Gennaro Sardella; Simone Calcagno; Francesco Gallo; Zenon Huczek; Marcin Krakowian; Roberto Verardi; Antonio Montefusco; Pierluigi Omedè; Marco Lococo; Claudio Moretti; Maurizio D'Amico; Stefano Rigattieri; Fiorenzo Gaita; Mauro Rinaldi; Javier Escaned Journal: Int J Cardiol Date: 2018-06-08 Impact factor: 4.164
Authors: Stuart J Head; Milan Milojevic; Joost Daemen; Jung-Min Ahn; Eric Boersma; Evald H Christiansen; Michael J Domanski; Michael E Farkouh; Marcus Flather; Valentin Fuster; Mark A Hlatky; Niels R Holm; Whady A Hueb; Masoor Kamalesh; Young-Hak Kim; Timo Mäkikallio; Friedrich W Mohr; Grigorios Papageorgiou; Seung-Jung Park; Alfredo E Rodriguez; Joseph F Sabik; Rodney H Stables; Gregg W Stone; Patrick W Serruys; Arie Pieter Kappetein Journal: Lancet Date: 2018-02-23 Impact factor: 79.321
Authors: Mario Gaudino; Faisal G Bakaeen; Umberto Benedetto; Antonino Di Franco; Stephen Fremes; David Glineur; Leonard N Girardi; Juan Grau; John D Puskas; Marc Ruel; Derrick Y Tam; David P Taggart Journal: Circulation Date: 2019-10-07 Impact factor: 29.690
Authors: Mikael Dellborg; Marc P Bonaca; Robert F Storey; P Gabriel Steg; Kyung A Im; Marc Cohen; Deepak L Bhatt; Ton Oude Ophuis; Andrezej Budaj; Christian Hamm; Jindrich Spinar; Robert G Kiss; José Lopez-Sendon; Gabriel Kamensky; Frans Van de Werf; Diego Ardissino; Frederic Kontny; Gilles Montalescot; Per Johanson; Olof Bengtsson; Anders Himmelmann; Eugene Braunwald; Marc S Sabatine Journal: Eur Heart J Cardiovasc Pharmacother Date: 2019-10-01
Authors: Roberto Lorusso; Marco Moscarelli; Antonino Di Franco; Valentina Grazioli; Francesco Nicolini; Tiziano Gherli; Michele De Bonis; Maurizio Taramasso; Emmanuel Villa; Giovanni Troise; Roberto Scrofani; Carlo Antona; Giovanni Mariscalco; Cesare Beghi; Antonio Miceli; Mattia Glauber; Marco Ranucci; Carlo De Vincentiis; Mario Gaudino Journal: J Am Heart Assoc Date: 2019-12-13 Impact factor: 5.501
Authors: Jacopo Burrello; Guglielmo Gallone; Alessio Burrello; Daniele Jahier Pagliari; Eline H Ploumen; Mario Iannaccone; Leonardo De Luca; Paolo Zocca; Giuseppe Patti; Enrico Cerrato; Wojciech Wojakowski; Giuseppe Venuti; Ovidio De Filippo; Alessio Mattesini; Nicola Ryan; Gérard Helft; Saverio Muscoli; Jing Kan; Imad Sheiban; Radoslaw Parma; Daniela Trabattoni; Massimo Giammaria; Alessandra Truffa; Francesco Piroli; Yoichi Imori; Bernardo Cortese; Pierluigi Omedè; Federico Conrotto; Shao-Liang Chen; Javier Escaned; Rosaly A Buiten; Clemens Von Birgelen; Paolo Mulatero; Gaetano Maria De Ferrari; Silvia Monticone; Fabrizio D'Ascenzo Journal: J Pers Med Date: 2022-06-17
Authors: Jacqueline Schmidt-RioValle; Moath Abu Ejheisheh; María José Membrive-Jiménez; Nora Suleiman-Martos; Luis Albendín-García; María Correa-Rodríguez; José Luis Gómez-Urquiza Journal: Int J Environ Res Public Health Date: 2020-11-14 Impact factor: 3.390