Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Aged Patients With Unprotected Left Main Artery Lesions

Abstract

SummaryThere is still much debate about revascularization strategies in aged patients with unprotected left main coronary artery (UPLM) lesions. This study compared the outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in this population.A total of 126 patients older than 60 years of age with LM lesions who underwent revascularization in our hospital from January 2012 to December 2013 were followed up for an average of 15.2 months. The cumulative incidence of major adverse cardiac and cerebral events (MACCE) was estimated by Kaplan-Meier plots. During follow-up, the CABG group had higher proportions of cardiac death, stroke, and worsening of heart failure while the PCI group had a higher proportion of recurrence of angina (P = 0.04). The MACCE incidence was lower in the PCI group than that in the CABG group (28.9% versus 35.6%, P = 0.04). Multivariate regression identified left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) as predictors of PCI, while age, LVEF, EuroScore, and diabetes were the predictors of CABG. PCI maintained its superiority over CABG after adjustment for risk factors (Hazard ratio: 0.28, P = 0.004). The CABG group included a higher proportion of severe hemorrhagic complications than the PCI group (P = 0.04).In terms of efficacy and safety, PCI had an advantage over CABG in aged patients with UPLM lesions. Thus, PCI was a reasonable alternative to CABG for this population. (Int Heart J 2016; 57: 682-688) Key words: Left main coronary artery, Predictor, Revascularization, Major adverse cardiac and cerebral events C oronary artery bypass graft (CABG) remains the preferable strategy for unprotected left main artery (UPLM) lesions in the recent guideline. 1) However, accompanied by the emergence of drug-eluting stents (DES) and intravascular ultrasound (IVUS), percutaneous coronary intervention (PCI) has made great progress. Particularly for UPLM, previous studies have reported a low incidence of cardiac death and stent thrombosis 2-4) and the therapeutic effect was similar to that of CABG. 5,6) In the real world, increasing numbers of patients with LM lesions are also suitable candidates for PCI. Many prefer PCI to CABG because of aging, physical status, personal preference, and other factors. Thus, whether PCI of UPLM is superior to CABG in aged patients is a noteworthy topic. Only a few studies have examined this problem and the results were inconsistent. 7,8) We therefore carried out an observational study to evaluate whether PCI of UPLM in aged patients is superior to CABG. We also assessed likely predictors of the two revascularization strategies. MethodsStudy population: A total of 126 patients older than 60 years with LM lesions who underwent revascularization in our hospital from January 2012 to December 2013 were included in this study cohort. All of the patients were assessed with respect to the severity of coronary artery lesions by angiography. The patients with a SYNTAX score > 32 were recommended...

Role of Gene Polymorphisms/Haplotypes and Plasma Level of TGF-β1 in Susceptibility to In-Stent Restenosis Following Coronary Implantation of Bare Metal Stent in Chinese Han Patients

“…[1][2][3][4][5] In our study, the ISR and the non-ISR groups did not differ significantly in the main demographic, clinical, angiographic and biochemical parameters, whereas BMI, incidence of smoking, length of lesions, and stent per lesion were remarkably higher or longer in the ISR group. However, we did not consider the importance of these differences in the context of the study as no difference was detected in TGF-β1 869T/C polymorphism among genotypes.…”

“…1,2) Despite the remarkable advances in the pharmacology and technology of PCI, in-stent restenosis (ISR) is still an unsolved problem of this therapeutic strategy. 3,4) ISR occurs in approximately 30% of patients using bare metal stents and 10%-15% with drug eluting stents.…”

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

“…Previous studies 6,18,23,[26][27][28] did not have a primary focus on the clinical outcomes of non-complex LMCA disease treated with a single stenting technique. Only Agostoni, et al 22) reported that when ostial or mid-LMCA disease is treated with DES, the rate of cardiac events is particularly low.…”

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion

“…7,8) In addition, a recent observational study from Chinese investigators has shown that DES-based PCI was superior to CABG in reducing major adverse cardiac/cerebral events and bleeding complications among aged patients (average age 72.5, range 60-89) with nonprotected LMCA-disease. 9) However, restenosis of the DES implanted in LMCA is not uncommon (reaching 10% to 20%), [10][11][12] and it could theoretically provoke a broad myocardial ischemia, leading to a fatal outcome. According to a retrospective registry of 70 restenotic cases RA AND DCB FOR LM-ACS WITH RCA-CTO from 718 patients undergoing PCI with DES for LMCA disease, 30.8% and 29.4% of the restenotic cases presented with ACS and stable angina, respectively.…”