Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction
Autor: | Iris-Main Registry Investigators, Do-Yoon Kang, Pil Hyung Lee, Sangwoo Park, Tae Oh Kim, Ju Hyeon Kim, Yujin Yang, Kyungjin Choe, Duk-Woo Park, Junho Hyun, Yeong Jin Jeong, Hanbit Park, Jung-Min Ahn, Junghoon Lee, Seung-Jung Park |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization Cohort Studies Ventricular Dysfunction Left 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine Republic of Korea Humans Medicine Registries cardiovascular diseases 030212 general & internal medicine Coronary Artery Bypass Stroke Aged Ejection fraction business.industry Hazard ratio Percutaneous coronary intervention Middle Aged medicine.disease Confidence interval medicine.anatomical_structure Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
Zdroj: | Journal of the American College of Cardiology. 76:1395-1406 |
ISSN: | 0735-1097 |
Popis: | Left main coronary artery (LMCA) disease is associated with high mortality and morbidity due to a large area of jeopardized myocardium. However, the optimal revascularization strategy for patients with LMCA disease and left ventricular dysfunction is still unclear.This study sought to examine long-term comparative outcomes after percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG) according to the severity of left ventricular dysfunction.The authors evaluated a total of 3,488 patients with LMCA disease who underwent CABG (n = 1,355) or PCI (n = 2,133) from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry. Left ventricular function was categorized according to left ventricular ejection fraction (LVEF) as normal function (LVEF ≥55%), mild dysfunction (LVEF ≥45% to 55%), moderate dysfunction (LVEF ≥35% to 45%), or severe dysfunction (LVEF 35%). The primary outcome was a composite of death, myocardial infarction, or stroke.Among the overall patient population, 2,641 (75.7%) patients had normal LVEF and 403 (11.6%), 260 (7.5%), and 184 (5.3%) had mild, moderate, and severe left ventricular dysfunction at baseline, respectively. Compared with CABG, PCI was associated with a higher adjusted risk of primary outcomes in patients with moderate (hazard ratio [HR]: 2.23; 95% confidence interval [CI]: 1.17 to 4.28) or severe (HR: 2.45; 95% CI: 1.27 to 4.73) dysfunction. In contrast, PCI and CABG had similar risks of the primary outcomes in patients with normal (HR: 0.80; 95% CI: 0.59 to 1.07) or mild (HR: 1.17; 95% CI: 0.63 to 2.17) dysfunction (p for interaction = 0.004).In the revascularization of LMCA disease, PCI was associated with an inferior primary composite outcome of death, MI, or stroke compared with CABG in patients with moderate or severe left ventricular dysfunction. However, the risk for the primary outcome was comparable between PCI and CABG in those with normal or mild left ventricular dysfunction. (Observational Study for Left Main Disease Treatment; NCT01341327). |
Databáze: | OpenAIRE |
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