Five-year outcomes after PCI or CABG for left main coronary disease
| Autor: | Stuart J. Pocock, Mark Hickey, Nicholas Lembo, John Gregson, Paweł Buszman, Gábor Bogáts, Ioanna Kosmidou, Nicolas Noiseux, Dimitri Karmpaliotis, Roxana Mehran, Ferenc Horkay, Erick Schampaert, Andrzej Bochenek, Joseph F. Sabik, José L. Pomar, Charles A. Simonton, A. Pieter Kappetein, Marie-Claude Morice, Adrian P. Banning, Patrick W. Serruys, Béla Merkely, John D. Puskas, Ovidiu Dressler, Rodrigo Modolo, Manel Sabaté, Piet W. Boonstra, Philippe Généreux, Imre Ungi, Aaron Crowley, Anthony H. Gershlick, W. Morris Brown, Ad J. van Boven, Samer Mansour, Pierre Pagé, David E. Kandzari, Gregg W. Stone |
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| Přispěvatelé: | Cardiothoracic Surgery |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Bypass grafting medicine.medical_treatment Myocardial Infarction Myocardial Ischemia Coronary Artery Disease 030204 cardiovascular system & hematology Coronary disease 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine Odds Ratio medicine Humans In patient Everolimus cardiovascular diseases 030212 general & internal medicine Coronary Artery Bypass Aged business.industry Percutaneous coronary intervention Drug-Eluting Stents General Medicine Middle Aged Stroke surgical procedures operative Conventional PCI Cardiology Female business |
| Zdroj: | New England Journal of Medicine, 381(19), 1820-1830. Massachussetts Medical Society |
| ISSN: | 0028-4793 |
| Popis: | BACKGROUND Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. METHODS We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. RESULTS At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], −0.9 to 6.5; P=0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, −1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, −1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, −1.9 percentage points; 95% CI, −3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, −0.8 percentage points; 95% CI, −2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). CONCLUSIONS In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.) |
| Databáze: | OpenAIRE |
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