Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease
Background: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outc...
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doaj-5a0ce5cb837e40afa0e4152e172bdb752020-11-24T21:32:00ZengWolters KluwerChinese Medical Journal0366-69992016-01-01129776377010.4103/0366-6999.178968Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery DiseaseXian-Peng YuChang-Yan WuXue-Jun RenFei YuanXian-Tao SongYa-Wei LuoJi-Qiang HeYue-Chun GaoFang-Jiong HuangCheng-Xiong GuLi-Zhong SunShu-Zheng LyuFang ChenBackground: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. Methods: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. Conclusions: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.http://www.cmj.org/article.asp?issn=0366-6999;year=2016;volume=129;issue=7;spage=763;epage=770;aulast=YuCoronary Artery Bypass Grafting; Drug-eluting Stents; Percutaneous Coronary Intervention; Unprotected Left Main Coronary Artery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xian-Peng Yu Chang-Yan Wu Xue-Jun Ren Fei Yuan Xian-Tao Song Ya-Wei Luo Ji-Qiang He Yue-Chun Gao Fang-Jiong Huang Cheng-Xiong Gu Li-Zhong Sun Shu-Zheng Lyu Fang Chen |
spellingShingle |
Xian-Peng Yu Chang-Yan Wu Xue-Jun Ren Fei Yuan Xian-Tao Song Ya-Wei Luo Ji-Qiang He Yue-Chun Gao Fang-Jiong Huang Cheng-Xiong Gu Li-Zhong Sun Shu-Zheng Lyu Fang Chen Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease Chinese Medical Journal Coronary Artery Bypass Grafting; Drug-eluting Stents; Percutaneous Coronary Intervention; Unprotected Left Main Coronary Artery |
author_facet |
Xian-Peng Yu Chang-Yan Wu Xue-Jun Ren Fei Yuan Xian-Tao Song Ya-Wei Luo Ji-Qiang He Yue-Chun Gao Fang-Jiong Huang Cheng-Xiong Gu Li-Zhong Sun Shu-Zheng Lyu Fang Chen |
author_sort |
Xian-Peng Yu |
title |
Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease |
title_short |
Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease |
title_full |
Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease |
title_fullStr |
Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease |
title_full_unstemmed |
Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease |
title_sort |
very long-term outcomes and predictors of percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting for patients with unprotected left main coronary artery disease |
publisher |
Wolters Kluwer |
series |
Chinese Medical Journal |
issn |
0366-6999 |
publishDate |
2016-01-01 |
description |
Background: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.
Methods: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.
Results: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.
Conclusions: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group. |
topic |
Coronary Artery Bypass Grafting; Drug-eluting Stents; Percutaneous Coronary Intervention; Unprotected Left Main Coronary Artery |
url |
http://www.cmj.org/article.asp?issn=0366-6999;year=2016;volume=129;issue=7;spage=763;epage=770;aulast=Yu |
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