Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery for the Treatment of Unprotected Left Main Coronary Artery Stenosis In-Hospital and One Year Outcome After Emergent and Elective Treatments

Abstract

SUMMARYThis study attempts to compare the risks and benefits of provisional stenting with drug eluting stents and bypass surgery for left main coronary artery (LMCA) stenosis.Recent improvements in interventional technologies have increased interest in percutaneous treatment of LMCA stenosis. However, application of percutaneous techniques to LMCA has been sporadic and controversial.In-hospital and one year outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) cases were compared. From September, 2003 to June, 2005, a total of 59 consecutive patients with de novo unprotected LMCA stenosis were treated with either CABG or PCI. Twenty patients received non-intravascular ultrasound-guided PCI with a stent in the LMCA. Thirty-nine patients underwent CABG.At 30-day follow-up, the major adverse cardiac and cerebrovascular event (MACE) rates of mortality, myocardial infarction, cerebral vascular accident, and target vessel revascularization were 25.6% in the CABG group and 5% in the PCI group (P = 0.054).At one year follow-up, the MACE rates were 33.3% in the CABG group and 5% in the PCI group. One year MACE for the CABG group significantly differed from that of the PCI group (P = 0.015). The odds ratio (OR) of one year MACE-free survival was 0.75 (P < 0.001) in the CABG group versus the PCI group. Further analysis demonstrated there was a significant difference in in-hospital MACE and one year MACE between the elective CABG group and elective PCI group (P = 0.045). However, there was no significant difference between the emergent CABG group and emergent PCI group (P = 1.000 for in-hospital MACE; P = 0.486 for one year MACE).PCI on unprotected LM offers an alternative option in patients with high surgical risk and appropriate lesion morphology. (Int Heart J 2008; 49: 355-370)

A Meta-Analysis of 3,773 Patients Treated With Percutaneous Coronary Intervention or Surgery for Unprotected Left Main Coronary Artery Stenosis

“…We identified 13 eligible studies (13-22,26 -28) that compared PCI and CABG cohorts for the treatment of ULMCA coronary stenosis. Three of these studies were excluded because of: 1) probable overlap with the institution's previous report ( 2) subgroup analysis (27,28); and 3) Ͻ30 PCI patients were studied (26). Figure 1 demonstrates our search process.…”

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

“…The reported incidence of atrial fibrillation after PCI varies between 6.2% and 8.0% in patients undergoing primary PCI for myocardial infarction. 25 The mechanisms for post-PCI atrial fibrillation are poorly understood. It is induced most commonly in response to catheter placement into or out of the right atrium and during balloon occlusion of the coronary vessels.…”

Outcomes of coronary artery interventions: Comparing coronary artery bypass surgery and percutaneous coronary intervention in patients with unprotected left main stenosis

“…The cohort study design is predominant in the studies used for this literature review. Of the 12 cohort studies, eight were retrospective (Chieffo et al., ; Ghenim et al., ; Kang et al., 2010; Palmerini et al., ; Park, Kim et al., ; Park, Seung et al., ; Seung et al., ; Wu et al., ) and four were prospective (Brener, Galla, Bryant, Sabik, & Ellis, ; Caggegi et al., ; Hsu, Chu, Chang, Kao, & Chung, ; Park, Kim, Yun et al., ). Cohort studies generally obtained data from patient medical records and existing databases.…”

“…The remaining four studies were randomized trials (Boudriot et al., ; Buszman et al., ; Morice et al., ; Park, Kim, Park et al., ). Five of the studies were classified for this review as short‐term follow‐up and outcome assessment during the period immediately postintervention (in‐hospital) and up to 1 year (Boudriot et al., ; Caggegi et al., ; Ghenim et al., ; Hsu et al., ; Morice et al., ). Eleven studies had long‐term follow‐up and outcome assessment ranging from 2 to 10 years (Brener et al., ; Buszman et al., ; Chieffo et al., ; Kang et al., 2010; Palmerini et al., ; Park, Kim et al., ; Park, Kim, Park et al., ; Park, Kim, Yun et al., ; Park, Seung et al., ; Seung et al., ; Wu et al., ).…”