Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease

Journal of Clinical Medicine

Albert Youngwoo Jang¹  Seung Hwan Han¹  Yong Hoon Shin¹  Pyung Chun Oh¹  Woong Chol Kang¹  Joonpyo Lee¹  Soon Yong Suh¹  Minsu Kim¹  Jeongduk Seo¹  Kyounghoon Lee¹  Taehoon Ahn² 

[1] Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea;Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Korea;

关键词: left main disease;    percutaneous coronary intervention;    coronary artery bypass surgery;    long-term outcomes;    real world;    decision making;   

DOI  :  10.3390/jcm11030503

来源: DOAJ

【 摘 要 】

Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (n = 230) with LM disease either treated by PCI (n = 118) or CABG (n = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HR_adj 0.97, 95% CI [0.48–1.94], p = 0.92) and a lower tendency of hard MACE (HR_adj 0.49, 95% CI [0.22–1.07], p = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HR_adj 9.71, p = 0.02) and a lower rate of stroke (HR_adj 0.22, p = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment.

【 授权许可】

Unknown