Key result
PCI matches CABG for 3-year MACCE in unprotected left main disease.
Why the study?
The management and long-term outcomes of revascularisation for unprotected left main stem disease in a non-surgical centre required prospective analysis to inform practice.
Observational (n=56)
No
Absolute Event Rate: 29.6% vs 27.5%
p-value: p=0.99
PCI associated with similar 3-year MACCE versus CABG in this small cohort; leaves open need for randomized confirmation before practice change.
Purpose: In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre. Methods: This prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days. Results: 56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort. Conclusions: PCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.
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Coughlan et al. (2018) conducted an observational in Unprotected left main stem disease (n=56). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) at 3 years (p=0.99). Percutaneous coronary intervention for unprotected left main stem disease resulted in a similar rate of major adverse cardiovascular and cerebrovascular events at 3 years compared to coronary artery bypass grafting (29.6% vs 27.5%, p=0.99).
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