Major Predictors of Long-Term Clinical Outcomes After Coronary Revascularization in Patients With Unprotected Left Main Coronary Disease

Min, Sun-Yang; Park, Duk‐Woo; Yun, Sung‐Cheol; Kim, Young‐Hak; Lee, Jong‐Young; Kang, Soo–Jin; Lee, Seung-Whan; Lee, Cheol Whan; Kim, Jae‐Joong; Park, Seong-Wook; Park, Seung‐Jung

doi:10.1161/circinterventions.109.890053

Cited by 56 publications

(33 citation statements)

References 39 publications

(38 reference statements)

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“…Similar to previous reports involving multivessel CAD treated with PCI or CABG, [18][19][20][21] we found that renal insufficiency, low EF, age, and diabetes mellitus were the strongest predictors of MACCE and all-cause mortality in patients with ULMCA disease. In addition to these strongest predictors, other key predictors of major clinical events or death were peripheral vascular disease, atrial fibrillation, chronic lung disease, previous stroke, acute coronary syndrome, or high body mass index.…”

Section: Discussionsupporting

confidence: 90%

Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication

Kang¹,

Ahn²,

Lee³

et al. 2017

Circ: Cardiovascular Interventions

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P atients with unprotected left main coronary artery (ULMCA) disease are considered at highest-risk of adverse cardiovascular events and mortality within the broad range of risk for patients with obstructive coronary artery disease (CAD). On the basis of several clinical and anatomic characteristics and patient/physician preference, individual patients with ULMCA disease might be treated with percutaneous coronary intervention (PCI), coronary-artery bypass grafting (CABG), or medication alone.1 Depending on the specific index treatment strategy, accurate knowledge of the key determinants of adverse cardiovascular events and mortality would be extremely useful for clinical and investigational purposes. To date, several scoring systems have been developed for risk stratification and decision making of optimum revascularization strategy in patients with complex CAD with or without ULMCA disease.2-5 However, easy application of these scoring systems in clinical practice might be hampered because of limited clinical performance and complexities. In particular, 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; coronaryartery 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. Un...

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Section: Discussionsupporting

confidence: 90%

Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication

Kang¹,

Ahn²,

Lee³

et al. 2017

Circ: Cardiovascular Interventions

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“…Finally, as previously reported, 14,20,21 our study demonstrated that low e-GFR<60, DM, high EuroScore, and low EF were significantly associated with long-term cardiac-mortality. Furthermore, presence of residual CTO-RCA played a significant important role in the cardiac-mortality among the other anatomic information.…”

Section: Discussionsupporting

confidence: 88%

Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease

Takagi

Ielasi

Chieffo

et al. 2013

Circ: Cardiovascular Interventions

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W ith continual improvements in stent technology and adjunctive pharmacotherapy, we have supportive evidence regarding percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation in selected unprotected left main (ULM) lesions involving ostium/body or distal bifurcation with low-to-moderate SYNTAX scores. [1][2][3][4][5][6][7][8] Conversely, in patients with SYNTAX score >32, coronary artery bypass grafting (CABG) is recommended. 9 The presence of chronic total occlusion of the right coronary artery (CTO-RCA) contributes to the generation of a high SYNTAX score in patients with ULM stenosis. There is scarcity of data on the impact of residual CTO-RCA in patients undergoing PCI for ULM, and we aim to study this aspect in our cohort of patients. MethodsBetween P=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank P=0.01) despite no difference in baseline characteristics. Conclusions-Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the longterm cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main. (Circ Cardiovasc Interv. 2013;6:154-160.)Key Words: chronic total coronary occlusion ◼ drug-eluting stent ◼ left main coronary artery ◼ right coronary artery

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“…• The EuroSCORE validated to predict surgical mortality was recently shown to be an independent predictor of major adverse cardiac events (MACEs) in studies with both percutaneous and surgical treatment arms [2,3]. Therefore, it can be used to determine the risk of revascularization irrespective of, and even before, the selection of treatment strategy.…”

Section: Scores and Risk Stratification Impact Of Comorbiditymentioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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Major Predictors of Long-Term Clinical Outcomes After Coronary Revascularization in Patients With Unprotected Left Main Coronary Disease

Cited by 56 publications

References 39 publications

Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication

Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication

Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease

Guidelines on myocardial revascularization

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