Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches

Abstract

Significant unprotected left main (LM) coronary artery disease is frequently associated with severe multivessel disease and increased mortality and morbidity compared with non-LM coronary artery disease. This study compared the clinical outcomes of patients with LM disease who received percutaneous coronary intervention (PCI) with stenting, conventional coronary-artery bypass grafting (C-CABG), and robot-assisted CABG (R-CABG).This retrospective study analyzed 472 consecutive LM disease patients who underwent three different revascularization approaches at a tertiary medical center between January 2005 and November 2013.Of the 472 LM disease patients, 139 received R-CABG, 147 received C-CABG, and 186 received PCI. The need for target vessel revascularization (TVR) was highest in the PCI group. The R-CABG group had significantly lower rates of in-hospital and follow-up all-cause deaths compared with the other 2 groups (1.4% vs. 3.4% and 9.7%, P = .0058; 13.7% vs. 29.3% and 29.6%, P = .0023, respectively). Patients in the R-CABG group had significantly lower rates of intra-aortic balloon pump assistance, and shorter duration of ICU and total hospital stay compared to patients in the C-CABG group. However, revascularization modality, SYNTAX scores, and residual SYNTAX scores were not independent predictors of in-hospital or long-term mortality.In this cohort of LM disease patients treated at a tertiary medical center, PCI is a reasonable choice in patients with less lesion complexity but who are older and have comorbidities. R-CABG is feasible in stable LM disease patients with high SYNTAX scores, and is an effective alternative to C-CABG in LM disease patients with few risk factors. However, revascularization modality per se was not a determinant for long-term mortality in our real-world practice.

Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies

“…Of these, 13 were included in the review. [7][8][9][10][11][12][13][14][15][16][17][18][19] Detailed descriptions of included and excluded studies can be found in Appendix 1.…”

“…Two studies were based on national databases, 10,11 and the remaining 11 studies were singlecentre. [7][8][9][12][13][14][15][16][17][18][19] Patients were selected between 1998 and 2014, and sample sizes ranged from 38 to 966 211. Seven studies compared RCAB to C-CABG, on or off pump, 7,[12][13][14][15][16][17] 3 studies compared RCAB to MIDCAB, [17][18][19] and 1 study compared RCAB to PA-CAB.…”

“…With the Newcastle-Ottawa Scale, quality was rated as good in 1 study, 11 fair in 2, 12,13 and poor in 10. [7][8][9][10][14][15][16][17][18][19]…”

“…In 5 studies, the selection of patients for the control and intervention groups was unclear or not the same. 8,9,12,16,17 Three of the 5 did not state whether the eligibility criteria were the same between the RCAB group and the control group. 12,16,17 In 2 studies, patients were selected for the intervention and control groups based on availability of the technology and patient's and surgeon's preference.…”

Coronary artery bypass graft surgery versus percutaneous coronary intervention in unprotected left main coronary artery disease: A systematic review

“…The investigators concluded that PCI remains a fair choice in older patients with low to moderate SYNTAX score and R-CABG is a competent surrogate to standard CABG, with significantly lower duration of intensive care unit and total hospital stay. A similar, retrospective study compared the clinical outcomes of patients with MVD treated either by R-CABG or PCI with DES and reported similar in-hospital and long term-survival rates (follow-up for 5.7 ± 3.0 years, P < 0.001) for both arms, along with commensurate rates of stroke, MI and as expected, significant higher rates of revascularization with PCI (Su et al, 2018(Su et al, , 2019.…”