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
| Autor: | Chengxiong Gu, Yuechun Gao, Changyan Wu, Yawei Luo, Li-Zhong Sun, Shuzheng Lyu, Fang Chen, Xiantao Song, Fei Yuan, Xianpeng Yu, Xuejun Ren, Fang-jiong Huang, Jiqiang He |
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| Rok vydání: | 2016 |
| Předmět: |
Drug-eluting Stents
Male medicine.medical_specialty medicine.medical_treatment lcsh:Medicine Coronary Artery Disease 030204 cardiovascular system & hematology Coronary artery disease 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Interquartile range Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Coronary Artery Bypass Stroke Unprotected Left Main Coronary Artery Aged Coronary Artery Bypass Grafting Ejection fraction business.industry lcsh:R Percutaneous coronary intervention Stroke Volume General Medicine Stroke volume Middle Aged medicine.disease Surgery surgical procedures operative Conventional PCI Cardiology Original Article Female business |
| Zdroj: | Chinese Medical Journal, Vol 129, Iss 7, Pp 763-770 (2016) Chinese Medical Journal |
| ISSN: | 0366-6999 |
| DOI: | 10.4103/0366-6999.178968 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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