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Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment.
JACC Cardiovasc Interv. 2014 Apr; 7(4):354-61.JC

Abstract

OBJECTIVES

The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA).

BACKGROUND

Data regarding outcomes in these patients are limited.

METHODS

Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed.

RESULTS

At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090).

CONCLUSIONS

This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.

Authors+Show Affiliations

Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.Cardiovascular Institute, University of Ferrara, S. Anna Hospital, Ferrara, Italy.Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland.Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.Mount-Sinai Medical Center, New York, New York.Clinique Pasteur, Toulouse, France.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.Clinique Pasteur, Toulouse, France.Institut Hospitalier Jacques Cartier, Générale de Santé Massy, Massy, France.Institut Hospitalier Jacques Cartier, Générale de Santé Massy, Massy, France.Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

24630886

Citation

Naganuma, Toru, et al. "Long-term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Ostial/midshaft Lesions in Unprotected Left Main Coronary Artery From the DELTA Registry: a Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment." JACC. Cardiovascular Interventions, vol. 7, no. 4, 2014, pp. 354-61.
Naganuma T, Chieffo A, Meliga E, et al. Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc Interv. 2014;7(4):354-61.
Naganuma, T., Chieffo, A., Meliga, E., Capodanno, D., Park, S. J., Onuma, Y., Valgimigli, M., Jegere, S., Makkar, R. R., Palacios, I. F., Costopoulos, C., Kim, Y. H., Buszman, P. P., Chakravarty, T., Sheiban, I., Mehran, R., Naber, C., Margey, R., Agnihotri, A., ... Colombo, A. (2014). Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC. Cardiovascular Interventions, 7(4), 354-61. https://doi.org/10.1016/j.jcin.2013.11.014
Naganuma T, et al. Long-term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Ostial/midshaft Lesions in Unprotected Left Main Coronary Artery From the DELTA Registry: a Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment. JACC Cardiovasc Interv. 2014;7(4):354-61. PubMed PMID: 24630886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. AU - Naganuma,Toru, AU - Chieffo,Alaide, AU - Meliga,Emanuele, AU - Capodanno,Davide, AU - Park,Seung-Jung, AU - Onuma,Yoshinobu, AU - Valgimigli,Marco, AU - Jegere,Sanda, AU - Makkar,Raj R, AU - Palacios,Igor F, AU - Costopoulos,Charis, AU - Kim,Young-Hak, AU - Buszman,Piotr P, AU - Chakravarty,Tarun, AU - Sheiban,Imad, AU - Mehran,Roxana, AU - Naber,Christoph, AU - Margey,Ronan, AU - Agnihotri,Arvind, AU - Marra,Sebastiano, AU - Capranzano,Piera, AU - Leon,Martin B, AU - Moses,Jeffrey W, AU - Fajadet,Jean, AU - Lefevre,Thierry, AU - Morice,Marie-Claude, AU - Erglis,Andrejs, AU - Tamburino,Corrado, AU - Alfieri,Ottavio, AU - Serruys,Patrick W, AU - Colombo,Antonio, Y1 - 2014/03/14/ PY - 2013/11/13/received PY - 2013/11/21/accepted PY - 2014/3/18/entrez PY - 2014/3/19/pubmed PY - 2014/12/17/medline KW - coronary artery bypass grafting KW - ostial/midshaft lesion KW - percutaneous coronary intervention KW - unprotected left main coronary artery SP - 354 EP - 61 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 7 IS - 4 N2 - OBJECTIVES: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). BACKGROUND: Data regarding outcomes in these patients are limited. METHODS: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. RESULTS: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). CONCLUSIONS: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24630886/Long_term_clinical_outcomes_after_percutaneous_coronary_intervention_versus_coronary_artery_bypass_grafting_for_ostial/midshaft_lesions_in_unprotected_left_main_coronary_artery_from_the_DELTA_registry:_a_multicenter_registry_evaluating_percutaneous_coronary_intervention_versus_coronary_artery_bypass_grafting_for_left_main_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(14)00438-5 DB - PRIME DP - Unbound Medicine ER -