Key result
Emergency percutaneous coronary intervention significantly reduced the risk of major adverse cardiovascular and cerebrovascular events compared to coronary artery bypass grafting (HR 0.30) in patients with unprotected left main coronary artery disease.
Why the study?
The optimal revascularization strategy for patients with left main coronary artery disease in the emergency setting remains controversial.
Does percutaneous coronary intervention improve outcomes compared to coronary artery bypass grafting in patients with emergent and non-emergent unprotected left-main coronary artery disease?
Population
2138 patients undergoing LMCA revascularization across 14 centers
Comparison
PCI vs CABG in emergent and non-emergent settings
Design
Multicenter retrospective cohort study
Follow-up
Median 20 months (IQR: 10-37)
Authors
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PCI may offer advantages in emergent LMCA revascularization; leaves open need for randomized confirmation before practice change.
Cohort (n=2,138)
Yes
Does percutaneous coronary intervention improve outcomes compared to coronary artery bypass grafting in patients with emergent and non-emergent unprotected left-main coronary artery disease?
Hazard Ratio: 0.3 (95% CI 0.14–0.66)
Absolute Event Rate: 8.33% vs 11.85%
p-value: p=<0.003
PCI may be advantageous over CABG for revascularizing unprotected left main coronary artery disease in emergency settings, and in non-emergent settings for patients with intermediate EuroSCORE and low/intermediate SYNTAX scores.
Daoulah et al. (2023) conducted a cohort in Unprotected left main coronary artery (ULMCA) disease (n=2,138). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) at follow-up in emergent revascularization (HR 0.30, 95% CI 0.14-0.66, p=<0.003). Emergency percutaneous coronary intervention significantly reduced the risk of major adverse cardiovascular and cerebrovascular events compared to coronary artery bypass grafting (HR 0.30) in patients with unprotected left main coronary artery disease.
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