Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease
Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI...
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doaj-6ebe6119aeff4cb99007386b3c8c574d2020-11-25T00:09:27ZengAurora Health CareJournal of Patient-Centered Research and Reviews 2330-06982015-08-01239510310.17294/2330-0698.1045Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery DiseaseTonga Nfor0Kambiz Shetabi1Wael Hassan2Quinta Nfor3Jayant Khitha4Anjan Gupta5Tanvir Bajwa6Suhail Allaqaband7Aurora Health Care, Milwaukee, WIAurora Health Care, Milwaukee, WIAurora Health Care, Milwaukee, WIAurora Health Care, Milwaukee, WIAurora Cardiovascular Services, Aurora Health Care, Milwaukee, WIAurora Cardiovascular Services, Aurora Health Care, Milwaukee, WIAurora Cardiovascular Services, Aurora Health Care, Milwaukee, WIAurora Cardiovascular Services, Aurora Health Care, Milwaukee, WIPurpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P<0.001) and had shorter hospital stays (5.6 ± 5.7 days vs. 15.1 ± 10.6 days, P<0.001). Conclusions: The composite rate of death, myocardial infarction or stroke is similar for PCI and CABG in patients with symptomatic LM-3VD who have STS-predicted operative mortality > 5%.http://digitalrepository.aurorahealthcare.org/cgi/viewcontent.cgi?article=1045&context=jpcrrhigh riskthree-vessel diseaseleft mainHeart Teamstentingcoronary artery bypass grafting |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tonga Nfor Kambiz Shetabi Wael Hassan Quinta Nfor Jayant Khitha Anjan Gupta Tanvir Bajwa Suhail Allaqaband |
spellingShingle |
Tonga Nfor Kambiz Shetabi Wael Hassan Quinta Nfor Jayant Khitha Anjan Gupta Tanvir Bajwa Suhail Allaqaband Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease Journal of Patient-Centered Research and Reviews high risk three-vessel disease left main Heart Team stenting coronary artery bypass grafting |
author_facet |
Tonga Nfor Kambiz Shetabi Wael Hassan Quinta Nfor Jayant Khitha Anjan Gupta Tanvir Bajwa Suhail Allaqaband |
author_sort |
Tonga Nfor |
title |
Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease |
title_short |
Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease |
title_full |
Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease |
title_fullStr |
Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease |
title_full_unstemmed |
Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease |
title_sort |
clinical outcomes after drug-eluting stents versus coronary artery bypass surgery in high surgical risk patients with left main or three-vessel coronary artery disease |
publisher |
Aurora Health Care |
series |
Journal of Patient-Centered Research and Reviews |
issn |
2330-0698 |
publishDate |
2015-08-01 |
description |
Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD.
Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study.
Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P<0.001) and had shorter hospital stays (5.6 ± 5.7 days vs. 15.1 ± 10.6 days, P<0.001).
Conclusions: The composite rate of death, myocardial infarction or stroke is similar for PCI and CABG in patients with symptomatic LM-3VD who have STS-predicted operative mortality > 5%. |
topic |
high risk three-vessel disease left main Heart Team stenting coronary artery bypass grafting |
url |
http://digitalrepository.aurorahealthcare.org/cgi/viewcontent.cgi?article=1045&context=jpcrr |
work_keys_str_mv |
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