Comparison of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease at National Cardiovascular Centre Harapan Kita
AbstractBackground. Despite many studies had been done comparing the outcome of Percutaneous Coronary Intervention (PCI) versus Coronary Artery By-pass Grafting (CABG) in Unprotected Left Main Coronary Artery Disease (ULMCAD), there is none such study in Indonesia.
Aim. To compare the outcome of PCI versus CABG in ULMCAD patients at National Cardiovascular Centre Harapan Kita (NCCHK) Jakarta.
Methods. A retrospective cohort study was done including 137 ULMCAD NCCHK patients who underwent PCI (n = 67) or CABG (n = 70) from July 2008 until March 2010. One-year Major Adverse Cardio Cerebrovascular Event (MACCE) outcome as defined by death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR), were evaluated using Chi-square analysis, while Kaplan-Meier and Cox regression analysis were used to examine the survival curve of the mentioned intervention.
Results. One-year risk of composite MACCE (death, stroke, and TVR) (hazard ratio (HR): 1.267; 95% confidence interval (CI): 0.567 – 2.829, p = 0.564), and the risk of death (HR: 1.080; 95% CI: 0.405 – 2.878, p = 0.878) were not significantly different for patients undergoing PCI versus CABG. Proportion of stroke was significantly higher in the CABG group (8.6% vs 0.0%; p = 0.014), while proportion of TVR was significantly higher in the PCI group (13.4% vs 0.0%; p = 0.001). No MI event was documented in both groups.
Conclusion. During one-year follow up, PCI showed similar rate of composite MACCE and death, but higher TVR as compared to CABG in ULMCAD patients. Meanwhile CABG showed higher stroke rate as compare to PCI.
Silber S, Albertsson P, Aviles FF, et al. Guidelines for Percu-taneous Coronary Interventions of the European Society of Cardiology. Eur Heart J.2005;26:804-847.
Tommaso CL, Vogel JH, Vogel RA. Coronary Angioplasty in High-Risk Patients with Left Main Coronary Stenosis: Results from the National Registry of Elective Supported Angioplasty. Cathet Cardiovasc Diagn. 1992;25:169 –173.
Tan WA, Tamai H, Park SJ, et al. ULTIMA Investigators. Long-term Clinical Outcomes after Unprotected Left Main Trunk Percutaneous Revascularization in 279 Patients. Circulation. 2001;104:1609 –1614.
Baim DS, Mauri L, Cutlip DC. Drug-Eluting Stent for Unpro-tected Left Main Coronary Artery Disease. Are We Ready to Replace Bypass Surgery? J Am Coll Cardiol.2006;47:878-881.
Terstein PS. Percutaneous Revascularization Is the Preferred Strategy for Patients with Significant Left Main Coronary Stenosis. Circulation.2009;119:1021-1033.
Han YL, Wang SL, Jin QM, et al. Efficacy of Stenting for Un-protected Left Main Coronary Artery Disease in 297 patients. Chin Med J. 2006;119(7):544-550.
Lee MS, Kapoor N, Jamal F, et al. Comparison of Coronary Ar-tery Bypass Surgery With Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease. J Am Coll Cardiol. 2006;47:864 –870.
HuangHW, Brent BN, Shaw RE, et al. Trends in Percutaneous versus Surgical Revascularization of Unprotected Left Main Coronary Stenosis in The Drug-Eluting Stent Era: a Report from the American College of Cardiology-National Cardiovas-cular Data Registry (ACC-NCDR). Catheter Cardiovasc Interv. 2006;68:867–872.
Anthony JW, Gautam K, James MM, et al. Comparison of Coronary Artery Bypass Surgery and Percutaneous Drug-Eluting Stent Implantation for Treatment of Left Main Coronary Artery Stenosis. J Am Coll Cardiol Intv. 2008;1;236-245.
Buszman PE, Kiesz SR, Bochenek A, et al. Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison with Surgical Revascularization. J Am Coll Cardiol. 2008;51:538-545.
Seung KB, Park DW, Kim YH, et al. Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease. N Engl J Med.2008;358:1781-1792.
Meliga E, Garcia-Garcia HM, Valgimigli M, et al. Longest Available Clinical Outcomes After Drug-Eluting Stent Implanta-tion for Unprotected Left Main Coronary Artery Disease. The DELFT (Drug Eluting stent for LeFT main) Registry. J Am Coll Cardiol2008;51:2212–2219.
Vaquerizo B, Lefevre T, Darremont O, et al. Unprotected Left Main Stenting in the Real World. Two-Year Outcomes of the French Left Main Taxus Registry. Circulation.2009;119:2349-2356.
Serruys PW, Morice MC, Kappetein AP, et al. Percutane-ous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N Engl J Med. 2009;360:961-972.
Park DW, Seung KB, Kim YH, et al. Long-Term Safety and Efficacy of Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: 5-Year Results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry. J Am Coll Cardiol. 2010;56:117-124.
Tamburino C. Left Main Coronary Artery Disease. A Practical Guide for The Interventional Cardiologist. Springer. 2009
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an Angiographic Tool Grading the Complexity of Coronary Artery Disease. EuroInterv.2005;1:219-227.
Serruys PW, Mohr FW. MD. The new data: SYNTAX Trial-Left Main Stratification. Paper presented at: TCT 2008, October 15, 2008; Washington, US.
Capodanno D, Capranzano P, Di Salvo ME, et al. Usefulness of SYNTAX Score to Select Patients With Left Main Coronary Artery Disease to Be Treated With Coronary Artery Bypass Graft. J Am Coll Cardiol Intv. 2009;2:731-738.
Singh M, Gersh BJ, McClelland RL, et al. Predictive factors for ischemic target vessel revascularization in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial .J Am Coll Cardiol. 2005; 45:198-203.
Stamou SC, Hill PC, Dangas G, et al. Stroke After Coronary Artery Bypass. Incidence, Predictors, and Clinical Outcome. Stroke. 2001;32:1508-1513.
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