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聽Coronary Artery Bypass Grafting for Left Main Treatment

详细信息    查看全文

• 作者：Toru Naganuma ; MD^&lowast ; ; Alaide Chieffo ; MD^&lowast ; ; Emanuele Meliga ; MD^&dagger ; ; Davide Capodanno ; MD ; PhD^&Dagger ; ; Seung-Jung Park ; MD^§ ; ; Yoshinobu Onuma ; MD^鈥?/sup> ; Marco Valgimigli ; MD^¶ ; ; Sanda Jegere ; MD^# ; ^&lowast ; &lowast ; ; Raj R. Makkar ; MD^&dagger ; &dagger ; ; Igor F. Palacios ; MD^&Dagger ; &Dagger ; ; Charis Costopoulos ; MD^&lowast ; ; Young-Hak Kim ; MD^§ ; ; Piotr P. Buszman ; MD ; PhD^§ ; § ; ; Tarun Chakravarty ; MD^&dagger ; &dagger ; ; Imad Sheiban ; MD^{鈥栤€?/sup>} ; Roxana Mehran ; MD^¶ ; ¶ ; ; Christoph Naber ; MD^&lowast ; &lowast ; &lowast ; ; Ronan Margey ; MD^&Dagger ; &Dagger ; ; Arvind Agnihotri ; MD^&Dagger ; &Dagger ; ; Sebastiano Marra ; MD^{鈥栤€?/sup>} ; Piera Capranzano ; MD^&Dagger ; ; Martin B. Leon ; MD^## ; Jeffrey W. Moses ; MD^## ; Jean Fajadet ; MD^&lowast ; &lowast ; &lowast ; ; Thierry Lefevre ; MD^&dagger ; &dagger ; &dagger ; ; Marie-Claude Morice ; MD^&dagger ; &dagger ; &dagger ; ; Andrejs Erglis ; MD^# ; ^&lowast ; &lowast ; ; Corrado Tamburino ; MD ; PhD^&Dagger ; ; Ottavio Alfieri ; MD^&lowast ; ; Patrick W. Serruys ; MD ; PhD^鈥?/sup> ; Antonio Colombo ; MD^&lowast ; ; ^{colombo.antonio@hsr.it" class="auth_mail}
• 关键词：coronary artery bypass grafting ; ostial/midshaft lesion ; percutaneous coronary intervention ; unprotected left main coronary artery
• 刊名：JACC: Cardiovascular Interventions
• 出版年：April, 2014
• 年：2014
• 卷：7
• 期：4
• 页码：354-361
• 全文大小：945 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferencesl version="1.0" encoding="UTF-8"?>

lass="h4">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).

lass="h4">Background

Data regarding outcomes in these patients are limited.

lass="h4">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聽= 482) or CABG (n聽= 374) were analyzed.

lass="h4">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聽= 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p聽= 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p聽= 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p聽= 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聽= 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聽= 0.090).

lass="h4">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.