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Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease.
J Invasive Cardiol. 2009 Nov; 21(11):564-9.JI

Abstract

Surgical myocardial revascularization (CABG) in patients with unprotected left main coronary artery disease (ULMCA) is a Class I recommendation in the AHA/ACC guidelines, however it is associated with increased perioperative risk in non-ST elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to compare early and late results after percutaneous coronary intervention (PCI) and CABG in this cohort of patients.

METHODS

A multicenter prospective registry included 138 patients with patent but severely narrowed (> 50%) ULMCA disease and NSTE-ACS diagnosed between January 2005 and April 2007. After emergent coronary angiography, 63 patients underwent PCI, whiles 75 were assigned for CABG.

RESULTS

Groups were comparable with regard to sex, age and prevalence of diabetes mellitus (DM). They had similar left ventricular ejection fraction, SYNTAX Score and incidence of distal LM stenosis. However, PCI patients were at higher surgical risk (Euroscore 8.7 +/- 3.7 vs. 7.4 +/- 3.0; p = 0.02) and myocardial infarction incidence (28% vs. 14%; p = 0.07). The 30-day mortality was 1.5% after PCI vs. 12% after CABG (p = 0.043) and major adverse cardiovascular and cerebrovascular events (MACCE) were 3.2% vs. 14.7%, respectively (p = 0.04). After 12 months, there were 4 deaths in the PCI group and 12 deaths in the CABG group (6.3% vs. 16%; p = 0.14). There was no difference in MACCE (9.5% vs. 9.3% p = ns). Kaplan-Meier analysis revealed a trend toward better survival after PCI (p = 0.07). Revascularization with CABG and a Euroscore > 5 were the independent risk factors influencing early survival, while a Euroscore > 6 was the independent predictor of late mortality.

CONCLUSIONS

PCI is a reasonable alternative to CABG in patients with NSTE-ACS and ULMCA stenosis.

Authors+Show Affiliations

Medical University of Silesia, Katowice, Poland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19901409

Citation

Buszman, Piotr P., et al. "Early and Long-term Outcomes After Surgical and Percutaneous Myocardial Revascularization in Patients With non-ST-elevation Acute Coronary Syndromes and Unprotected Left Main Disease." The Journal of Invasive Cardiology, vol. 21, no. 11, 2009, pp. 564-9.
Buszman PP, Bochenek A, Konkolewska M, et al. Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease. J Invasive Cardiol. 2009;21(11):564-9.
Buszman, P. P., Bochenek, A., Konkolewska, M., Trela, B., Kiesz, R. S., Wilczyński, M., Cisowski, M., Krejca, M., Banasiewicz-Szkróbka, I., Krol, M., Kondys, M., Wiernek, S., Orlik, B., Martin, J. L., Tendera, M., & Buszman, P. E. (2009). Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease. The Journal of Invasive Cardiology, 21(11), 564-9.
Buszman PP, et al. Early and Long-term Outcomes After Surgical and Percutaneous Myocardial Revascularization in Patients With non-ST-elevation Acute Coronary Syndromes and Unprotected Left Main Disease. J Invasive Cardiol. 2009;21(11):564-9. PubMed PMID: 19901409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease. AU - Buszman,Piotr P, AU - Bochenek,Andrzej, AU - Konkolewska,Magda, AU - Trela,Blazej, AU - Kiesz,R Stefan, AU - Wilczyński,Mirosław, AU - Cisowski,Marek, AU - Krejca,Michał, AU - Banasiewicz-Szkróbka,Iwona, AU - Krol,Marek, AU - Kondys,Marek, AU - Wiernek,Szymon, AU - Orlik,Bartłomiej, AU - Martin,Jack L, AU - Tendera,Michał, AU - Buszman,Pawel E, PY - 2009/11/11/entrez PY - 2009/11/11/pubmed PY - 2010/2/6/medline SP - 564 EP - 9 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 21 IS - 11 N2 - UNLABELLED: Surgical myocardial revascularization (CABG) in patients with unprotected left main coronary artery disease (ULMCA) is a Class I recommendation in the AHA/ACC guidelines, however it is associated with increased perioperative risk in non-ST elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to compare early and late results after percutaneous coronary intervention (PCI) and CABG in this cohort of patients. METHODS: A multicenter prospective registry included 138 patients with patent but severely narrowed (> 50%) ULMCA disease and NSTE-ACS diagnosed between January 2005 and April 2007. After emergent coronary angiography, 63 patients underwent PCI, whiles 75 were assigned for CABG. RESULTS: Groups were comparable with regard to sex, age and prevalence of diabetes mellitus (DM). They had similar left ventricular ejection fraction, SYNTAX Score and incidence of distal LM stenosis. However, PCI patients were at higher surgical risk (Euroscore 8.7 +/- 3.7 vs. 7.4 +/- 3.0; p = 0.02) and myocardial infarction incidence (28% vs. 14%; p = 0.07). The 30-day mortality was 1.5% after PCI vs. 12% after CABG (p = 0.043) and major adverse cardiovascular and cerebrovascular events (MACCE) were 3.2% vs. 14.7%, respectively (p = 0.04). After 12 months, there were 4 deaths in the PCI group and 12 deaths in the CABG group (6.3% vs. 16%; p = 0.14). There was no difference in MACCE (9.5% vs. 9.3% p = ns). Kaplan-Meier analysis revealed a trend toward better survival after PCI (p = 0.07). Revascularization with CABG and a Euroscore > 5 were the independent risk factors influencing early survival, while a Euroscore > 6 was the independent predictor of late mortality. CONCLUSIONS: PCI is a reasonable alternative to CABG in patients with NSTE-ACS and ULMCA stenosis. SN - 1557-2501 UR - https://www.unboundmedicine.com/medline/citation/19901409/Early_and_long_term_outcomes_after_surgical_and_percutaneous_myocardial_revascularization_in_patients_with_non_ST_elevation_acute_coronary_syndromes_and_unprotected_left_main_disease_ L2 - http://www.invasivecardiology.com/articles/Early-and-Long-Term-Outcomes-after-Surgical-and-Percutaneous-Myocardial-Revascularization-P DB - PRIME DP - Unbound Medicine ER -