Left Main Coronary Artery Disease, PTCA Left Main Artery Complications, Restenosis, Coronary
Conditions
Keywords
unprotected left main, in-stent restenosis, coronary artery bypass graft, percutaneous coronary intervention
Brief summary
Left main (LM) coronary artery disease is associated with high morbidity and mortality owing to the large myocardial territory at risk for ischemia. Evidence from randomized controlled trials supports that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for LM disease is an acceptable treatment strategy compared with coronary artery bypass graft surgery in patients with low or intermediate anatomic complexity. However in-stent restenosis (ISR) after DES in LM disease is still occurring with an incidence of 9,7%. Studies comparing the percutaneous coronary intervention with coronary artery bypass grafting (CABG) in the treatment of in-stent restenosis in unprotected left main have been scarce. While surgical revascularization is considered to be the standard treatment for this kind of stent failure, owing to a high risk of perioperative morbidity and mortality, the restoration of flow with PCI may be a reliable alternative. Additionally, it is not clear whether re-PCI is safe in these patients. Therefore, the purpose of the present study was to compare long-term outcomes following PCI or CABG for UPLM-ISR disease.
Interventions
PROCEDUREPCI vs. CABG
PCI vs. CABG
Sponsors
Medical University of Silesia
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Inclusion criteria
Patients were divided into two separate cohorts for the analyses. The data included consecutive patients with ≥50% diameter UPLM-ISR, with or without multivessel coronary artery disease. Patients with an equivalent of UPLM-ISR: left main distal bifurcation disease, within the proximal 5 mm of the left anterior descending artery (LAD) or left circumflex artery (LCx) ostium (in the absence of significant angiographic stenosis in the left main coronary artery), were eligible. Patients who had protected LM-ISR, defined as the occurrence of at least one patent arterial or venous graft to the left coronary artery, other concomitant non-CABG procedure during surgery, were excluded.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| MACCE | 4 years |
Secondary
| Measure | Time frame |
|---|---|
| cardiac death | 4 years |
| myocardial infarction | 4 years |
| target vessel revascularization | 4 years |
| stroke | 4 years |
Countries
Italy, Poland
Outcome results
None listed