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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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Autores principales: Yu, Xian-Peng, Wu, Chang-Yan, Ren, Xue-Jun, Yuan, Fei, Song, Xian-Tao, Luo, Ya-Wei, He, Ji-Qiang, Gao, Yue-Chun, Huang, Fang-Jiong, Gu, Cheng-Xiong, Sun, Li-Zhong, Lyu, Shu-Zheng, Chen, Fang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819294/
https://www.ncbi.nlm.nih.gov/pubmed/26996469
http://dx.doi.org/10.4103/0366-6999.178968
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author Yu, Xian-Peng
Wu, Chang-Yan
Ren, Xue-Jun
Yuan, Fei
Song, Xian-Tao
Luo, Ya-Wei
He, Ji-Qiang
Gao, Yue-Chun
Huang, Fang-Jiong
Gu, Cheng-Xiong
Sun, Li-Zhong
Lyu, Shu-Zheng
Chen, Fang
author_facet Yu, Xian-Peng
Wu, Chang-Yan
Ren, Xue-Jun
Yuan, Fei
Song, Xian-Tao
Luo, Ya-Wei
He, Ji-Qiang
Gao, Yue-Chun
Huang, Fang-Jiong
Gu, Cheng-Xiong
Sun, Li-Zhong
Lyu, Shu-Zheng
Chen, Fang
author_sort Yu, Xian-Peng
collection PubMed
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.
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spelling pubmed-48192942016-04-05 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 Yu, Xian-Peng Wu, Chang-Yan Ren, Xue-Jun Yuan, Fei Song, Xian-Tao Luo, Ya-Wei He, Ji-Qiang Gao, Yue-Chun Huang, Fang-Jiong Gu, Cheng-Xiong Sun, Li-Zhong Lyu, Shu-Zheng Chen, Fang Chin Med J (Engl) Original Article 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. Medknow Publications & Media Pvt Ltd 2016-04-05 /pmc/articles/PMC4819294/ /pubmed/26996469 http://dx.doi.org/10.4103/0366-6999.178968 Text en Copyright: © 2016 Chinese Medical Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Yu, Xian-Peng
Wu, Chang-Yan
Ren, Xue-Jun
Yuan, Fei
Song, Xian-Tao
Luo, Ya-Wei
He, Ji-Qiang
Gao, Yue-Chun
Huang, Fang-Jiong
Gu, Cheng-Xiong
Sun, Li-Zhong
Lyu, Shu-Zheng
Chen, Fang
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 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_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_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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819294/
https://www.ncbi.nlm.nih.gov/pubmed/26996469
http://dx.doi.org/10.4103/0366-6999.178968
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