Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients

Palmerini, Tullio; Serruys, Patrick W.; Kappetein, Arie Pieter; Généreux, Philippe; Riva, Diego Della; Reggiani, Maria Letizia Bacchi; Christiansen, Evald Høj; Holm, Niels Ramsing; Thuesen, Leif; Mäkikallio, Timo H.; Morice, Marie Claude; Ahn, Jung‐Min; Park, Seung‐Jung; Thiele, Holger; Boudriot, Enno; Sabatino, M.; Romanello, Mattia; Biondi‐Zoccai, Giuseppe; Raphael, Cavalcante; Sabik, Joseph F.; Stone, Gregg W.

doi:10.1016/j.ahj.2017.05.005

Cited by 84 publications

(42 citation statements)

References 24 publications

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“…22 In another meta-analysis, including all the six trials available so far, missing data were collected by the principal investigators, enabling further subgroup analyses. 23 PCI was found to significantly reduce death, MI, or stroke by 36%, and stroke by 64% within 30 days. Percutaneous coronary intervention reduced periprocedural MI by 33%, largely driven by the results of the EXCEL trial, but this effect was offset by 93% more spontaneous MIs beyond 30 days after PCI.…”

Section: Meta-analyses Of Percutaneous Coronary Intervention Vs Coromentioning

confidence: 91%

“…Cardiac death differed in relation to angiographic complexity, such that it tended to be lower with PCI among patients with low SYNTAX scores and higher in patients with high SYNTAX scores. 23 Head et al 14 recently published a large (n = 11 518) collaborative, pooled analysis of individual patient data from 11 trials comparing PCI and CABG for LMCA or multivessel coronary artery disease (CAD). Among 4478 patients with LMCA disease, the 5-year rate of death was similar between PCI and CABG (10.7% vs. 10.5%, HR 1.07, 95% confidence interval 0.87-1.33; P = 0.52), regardless of diabetes status and SYNTAX score.…”

Section: Meta-analyses Of Percutaneous Coronary Intervention Vs Coromentioning

confidence: 99%

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Management of left main disease: an update

Fajadet

Capodanno

Stone

2018

European Heart Journal

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A severe narrowing of the left main coronary artery (LMCA), usually due to atherosclerosis, jeopardizes a large area of myocardium and increases the risk of major adverse cardiac events. Management strategies for LMCA disease include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). In general, PCI offers more rapid recovery and a lower early adverse event rate, whereas CABG offers a more durable procedure. The largest of six LMCA trials comparing PCI with CABG recently reported that in patients with site-reported low or intermediate anatomical complexity PCI was non-inferior to CABG with respect to the composite of death, stroke, or myocardial infarction at 3 years. This result was obtained on a background of contemporary PCI standards, including safer and more effective stents, intravascular imaging and physiology assessment. This review updates on the current management of LMCA disease, with an emphasis on clinical data and procedural knowledge supporting the use of PCI in a growing proportion of patients.

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Section: Meta-analyses Of Percutaneous Coronary Intervention Vs Coromentioning

confidence: 91%

Section: Meta-analyses Of Percutaneous Coronary Intervention Vs Coromentioning

confidence: 99%

Management of left main disease: an update

Fajadet

Capodanno

Stone

2018

European Heart Journal

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“…Com o início das angioplastias com o uso de stent farmacológico, a taxa de re-estenose estava presente entre 5 a 10% dos casos no ano de 2013, um indicador positivo quando comparado ao início do uso dos stents nos anos 80, quando esta relação estava entre 16 e 44%. 21 Os BVS previnem o remodelamento constritivo nos primeiros seis meses após implante, porém permitem o remodelamento expansivo após a perda de sua integridade mecânica. 22,23,24 Em relação ao remodelamento vascular expansivo, o estudo ABSORB II mostrou que as características basais dos pacientes, como sexo feminino, ICP prévia, maiores níveis de LDL-colesterol e centro necrótico da lesão são determinantes independentes em seguimento de três anos.…”

Section: Discussionunclassified

Desfechos clínicos dos pacientes submetidos à intervenção coronária percutânea com stent bioabsorvível eluidor de everolimus

Ribeiro¹,

Nascimento

Murakami

et al. 2018

Medicina (Ribeirao Preto. Online)

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Modelo: Estudo descritivo, transversal, retrospectivo. Objetivo: Identificar desfechos clínicos e a prevalência de uso da dupla antiagregação plaquetária (DAP) 30 dias e 12 meses após implante de stent bioabsorvível eluidor de everolimus (BVS). Metodologia e casuística: Foram coletados e analisados de maneira descritiva dados referentes a antecedentes clínicos, procedimento, resultados pós-procedimento e complicações intra-hospitalares, acompanhamento e antiagregação plaquetária 30 dias e um ano após implante de BVS de pacientes submetidos a intervenção coronária percutânea (ICP) com BVS. Resultados: 169 pacientes foram submetidos a 182 a ICP com BVS para tratamento de 298 lesões, com idade média de 56,9±10,8 anos, 84% do sexo masculino. Até quatro lesões foram abordadas por ICP, 49% na artéria descendente anterior, 81,2% graves (Ellis B2 e C), 99% em TIMI 3 pós-procedimento. Após o procedimento, o infarto agudo do miocárdio (IAM) sem supradesnivelamento do segmento ST foi a principal complicação intrahospitalar (11,5%). Trinta dias após a ICP, não houve complicações relacionadas ao procedimento e 93,4% estavam em DAP. Após um ano, três pacientes foram submetidos a nova ICP não relacionada ao vaso anteriormente abordado e 80,2% mantinham DAP. Ressalta-se que não ocorreu re-estenose clinicamente significativa no período de seguimento. Conclusão: A prevalência de uso de DAP foi alta e não houve complicações precoces ou tardias relacionadas à ICP com BVS, confirmando a segurança e efetividade do procedimento na instituição.

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“…PTCA/PCI are commonly utilized in the management of CAD, resulting in reduced angina [18], and are considered safe and effective [19,20]. However, vascular dysfunction and other complications such as re-stenosis and thrombosis are well recognized [21].…”

Section: Do Coronary Interventions Cause Arterial Injury?mentioning

confidence: 99%

Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

2019

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Coronary artery disease (CAD) is a leading cause of death worldwide, and percutaneous transluminal coronary angiography (PTCA) and/or percutaneous coronary intervention (PCI; angioplasty) are commonly used to diagnose and/or treat the obstructed coronaries. Exercise-based rehabilitation is recommended for all CAD patients; however, most guidelines do not specify when exercise training should commence following PTCA and/or PCI. Catheterization can result in arterial dysfunction and acute injury, and given that fact that exercise, particularly at higher intensities, is associated with elevated inflammatory and oxidative stress, endothelial dysfunction and a pro-thrombotic milieu, performing exercise post-PTCA/PCI may transiently elevate the risk of cardiac events. This review aims to summarize extant literature relating to the impacts of coronary interventions on arterial function, including the time-course of recovery and the potential deleterious and/or beneficial impacts of acute versus long-term exercise. The current literature suggests that arterial dysfunction induced by catheterization recovers 4-12 weeks following catheterization. This review proposes that a period of relative arterial vulnerability may exist and exercise during this period may contribute to elevated event susceptibility. We therefore suggest that CAD patients start an exercise-training program between 2 and 4 weeks post-PCI, recognizing that the literature suggest there is a "grey area" for functional recovery between 2-12 weeks post catheterization. The timing of exercise onset should take into consideration the individual characteristics of patients (age, severity of disease, comorbidities) and the intensity, frequency and duration of the exercise prescription.

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Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients

Cited by 84 publications

References 24 publications

Management of left main disease: an update

Management of left main disease: an update

Desfechos clínicos dos pacientes submetidos à intervenção coronária percutânea com stent bioabsorvível eluidor de everolimus

Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

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