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 - PubMed (original) (raw)

Observational Study

doi: 10.1016/j.jcin.2013.11.014. Epub 2014 Mar 14.

Alaide Chieffo 1, Emanuele Meliga 2, Davide Capodanno 3, Seung-Jung Park 4, Yoshinobu Onuma 5, Marco Valgimigli 6, Sanda Jegere 7, Raj R Makkar 8, Igor F Palacios 9, Charis Costopoulos 1, Young-Hak Kim 4, Piotr P Buszman 10, Tarun Chakravarty 8, Imad Sheiban [ 11](#full-view-affiliation-11 "Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy."), Roxana Mehran 12, Christoph Naber 13, Ronan Margey 9, Arvind Agnihotri 9, Sebastiano Marra [ 11](#full-view-affiliation-11 "Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy."), Piera Capranzano 3, Martin B Leon 14, Jeffrey W Moses 14, Jean Fajadet 13, Thierry Lefevre 15, Marie-Claude Morice 15, Andrejs Erglis 7, Corrado Tamburino 3, Ottavio Alfieri 1, Patrick W Serruys 5, Antonio Colombo 16

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Observational Study

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

Toru Naganuma et al. JACC Cardiovasc Interv. 2014 Apr.

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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.

Keywords: coronary artery bypass grafting; ostial/midshaft lesion; percutaneous coronary intervention; unprotected left main coronary artery.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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