6533b856fe1ef96bd12b3009

RESEARCH PRODUCT

Long-Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Ostial/Midshaft Lesions in Unprotected Left Main Coronary Artery From the DELTA Registry

Piera CapranzanoYoung-hak KimIgor F. PalaciosRaj MakkarMarco ValgimigliAndrejs ĒRglisJean FajadetSebastiano MarraAlaide ChieffoOttavio AlfieriPiotr P. BuszmanCharis CostopoulosThierry LefèvreSeung-jung ParkAntonio ColomboRoxana MehranPatrick W. SerruysToru NaganumaJeffrey W. MosesChristoph NaberYoshinobu OnumaImad SheibanMarie Claude MoriceEmanuele MeligaArvind K. AgnihotriSanda JegereDavide CapodannoRonan MargeyCorrado TamburinoMartin B. LeonTarun Chakravarty

subject

medicine.medical_specialtybusiness.industryIncidence (epidemiology)medicine.medical_treatmentHazard ratioPercutaneous coronary interventionEuroSCOREmedicine.diseaseConfidence intervalSurgerymedicine.anatomical_structureInternal medicineConventional PCImedicineCardiologyMyocardial infarctionbusinessCardiology and Cardiovascular MedicineArtery

description

Objectives The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). Background Data regarding outcomes in these patients are limited. Methods Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. Results At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). Conclusions This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES. (JAmColl Cardiol Intv 2014;7:354-61) (C) 2014 by the American College of CardiologyFoundation

yearjournalcountryeditionlanguage
2014-04-01JACC-Cardiovascular interventions
10.1016/j.jcin.2013.11.014https://hdl.handle.net/1765/69809