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PCI or CABG for left main coronary artery disease: the SWEDEHEART registry
AIMS: An observational nationwide all-comers prospective register study to analyse outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in unprotected left main coronary artery (LMCA) disease. METHODS AND RESULTS: All patients undergoing coronary angiogra...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406339/ https://www.ncbi.nlm.nih.gov/pubmed/37288564 http://dx.doi.org/10.1093/eurheartj/ehad369 |
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author | Persson, Jonas Yan, Jacinth Angerås, Oskar Venetsanos, Dimitrios Jeppsson, Anders Sjögren, Iwar Linder, Rikard Erlinge, David Ivert, Torbjörn Omerovic, Elmir |
author_facet | Persson, Jonas Yan, Jacinth Angerås, Oskar Venetsanos, Dimitrios Jeppsson, Anders Sjögren, Iwar Linder, Rikard Erlinge, David Ivert, Torbjörn Omerovic, Elmir |
author_sort | Persson, Jonas |
collection | PubMed |
description | AIMS: An observational nationwide all-comers prospective register study to analyse outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in unprotected left main coronary artery (LMCA) disease. METHODS AND RESULTS: All patients undergoing coronary angiography in Sweden are registered in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. Between 01/01/2005 and 12/31/2015, 11 137 patients with LMCA disease underwent CABG (n = 9364) or PCI (n = 1773). Patients with previous CABG, ST-elevation myocardial infarction (MI) or cardiac shock were excluded. Death, MI, stroke, and new revascularization during follow-up until 12/31/2015 were identified using national registries. Cox regression with inverse probability weighting (IPW) and an instrumental variable (IV), administrative region, were used. Patients undergoing PCI were older, had higher prevalence of comorbidity but lower prevalence of three-vessel disease. PCI patients had higher mortality than CABG patients after adjustments for known cofounders with IPW analysis (hazard ratio [HR] 2.0 [95% confidence interval (CI) 1.5–2.7]) and known/unknown confounders with IV analysis (HR 1.5 [95% CI 1.1–2.0]). PCI was associated with higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE; death, MI, stroke, or new revascularization) than CABG, with IV analysis (HR 2.8 [95% CI 1.8–4.5]). There was a quantitative interaction for diabetic status regarding mortality (P = 0.014) translating into 3.6 years (95% CI 3.3–4.0) longer median survival time favouring CABG in patients with diabetes. CONCLUSION: In this non-randomized study, CABG in patients with LMCA disease was associated with lower mortality and fewer MACCE compared to PCI after multivariable adjustment for known and unknown confounders. |
format | Online Article Text |
id | pubmed-10406339 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-104063392023-08-08 PCI or CABG for left main coronary artery disease: the SWEDEHEART registry Persson, Jonas Yan, Jacinth Angerås, Oskar Venetsanos, Dimitrios Jeppsson, Anders Sjögren, Iwar Linder, Rikard Erlinge, David Ivert, Torbjörn Omerovic, Elmir Eur Heart J Clinical Research AIMS: An observational nationwide all-comers prospective register study to analyse outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in unprotected left main coronary artery (LMCA) disease. METHODS AND RESULTS: All patients undergoing coronary angiography in Sweden are registered in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. Between 01/01/2005 and 12/31/2015, 11 137 patients with LMCA disease underwent CABG (n = 9364) or PCI (n = 1773). Patients with previous CABG, ST-elevation myocardial infarction (MI) or cardiac shock were excluded. Death, MI, stroke, and new revascularization during follow-up until 12/31/2015 were identified using national registries. Cox regression with inverse probability weighting (IPW) and an instrumental variable (IV), administrative region, were used. Patients undergoing PCI were older, had higher prevalence of comorbidity but lower prevalence of three-vessel disease. PCI patients had higher mortality than CABG patients after adjustments for known cofounders with IPW analysis (hazard ratio [HR] 2.0 [95% confidence interval (CI) 1.5–2.7]) and known/unknown confounders with IV analysis (HR 1.5 [95% CI 1.1–2.0]). PCI was associated with higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE; death, MI, stroke, or new revascularization) than CABG, with IV analysis (HR 2.8 [95% CI 1.8–4.5]). There was a quantitative interaction for diabetic status regarding mortality (P = 0.014) translating into 3.6 years (95% CI 3.3–4.0) longer median survival time favouring CABG in patients with diabetes. CONCLUSION: In this non-randomized study, CABG in patients with LMCA disease was associated with lower mortality and fewer MACCE compared to PCI after multivariable adjustment for known and unknown confounders. Oxford University Press 2023-06-08 /pmc/articles/PMC10406339/ /pubmed/37288564 http://dx.doi.org/10.1093/eurheartj/ehad369 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Persson, Jonas Yan, Jacinth Angerås, Oskar Venetsanos, Dimitrios Jeppsson, Anders Sjögren, Iwar Linder, Rikard Erlinge, David Ivert, Torbjörn Omerovic, Elmir PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title | PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title_full | PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title_fullStr | PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title_full_unstemmed | PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title_short | PCI or CABG for left main coronary artery disease: the SWEDEHEART registry |
title_sort | pci or cabg for left main coronary artery disease: the swedeheart registry |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406339/ https://www.ncbi.nlm.nih.gov/pubmed/37288564 http://dx.doi.org/10.1093/eurheartj/ehad369 |
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