Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease
Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (<i>n</i> = 230) with LM disease either treated by PCI (<i>n</i> = 1...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/3/503 |
| _version_ | 1797487054193426432 |
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| author | Albert Youngwoo Jang Minsu Kim Joonpyo Lee Jeongduk Seo Yong Hoon Shin Pyung Chun Oh Soon Yong Suh Kyounghoon Lee Woong Chol Kang Taehoon Ahn Seung Hwan Han |
| author_facet | Albert Youngwoo Jang Minsu Kim Joonpyo Lee Jeongduk Seo Yong Hoon Shin Pyung Chun Oh Soon Yong Suh Kyounghoon Lee Woong Chol Kang Taehoon Ahn Seung Hwan Han |
| author_sort | Albert Youngwoo Jang |
| collection | DOAJ |
| description | Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (<i>n</i> = 230) with LM disease either treated by PCI (<i>n</i> = 118) or CABG (<i>n</i> = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HR<sub>adj</sub> 0.97, 95% CI [0.48–1.94], <i>p</i> = 0.92) and a lower tendency of hard MACE (HR<sub>adj</sub> 0.49, 95% CI [0.22–1.07], <i>p</i> = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HR<sub>adj</sub> 9.71, <i>p</i> = 0.02) and a lower rate of stroke (HR<sub>adj</sub> 0.22, <i>p</i> = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment. |
| first_indexed | 2024-03-09T23:43:07Z |
| format | Article |
| id | doaj.art-b0989fde540441769e1752fbba456114 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:43:07Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b0989fde540441769e1752fbba4561142023-11-23T16:49:25ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111350310.3390/jcm11030503Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main DiseaseAlbert Youngwoo Jang0Minsu Kim1Joonpyo Lee2Jeongduk Seo3Yong Hoon Shin4Pyung Chun Oh5Soon Yong Suh6Kyounghoon Lee7Woong Chol Kang8Taehoon Ahn9Seung Hwan Han10Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDivision of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, KoreaDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaBackground: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (<i>n</i> = 230) with LM disease either treated by PCI (<i>n</i> = 118) or CABG (<i>n</i> = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HR<sub>adj</sub> 0.97, 95% CI [0.48–1.94], <i>p</i> = 0.92) and a lower tendency of hard MACE (HR<sub>adj</sub> 0.49, 95% CI [0.22–1.07], <i>p</i> = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HR<sub>adj</sub> 9.71, <i>p</i> = 0.02) and a lower rate of stroke (HR<sub>adj</sub> 0.22, <i>p</i> = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment.https://www.mdpi.com/2077-0383/11/3/503left main diseasepercutaneous coronary interventioncoronary artery bypass surgerylong-term outcomesreal worlddecision making |
| spellingShingle | Albert Youngwoo Jang Minsu Kim Joonpyo Lee Jeongduk Seo Yong Hoon Shin Pyung Chun Oh Soon Yong Suh Kyounghoon Lee Woong Chol Kang Taehoon Ahn Seung Hwan Han Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease Journal of Clinical Medicine left main disease percutaneous coronary intervention coronary artery bypass surgery long-term outcomes real world decision making |
| title | Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease |
| title_full | Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease |
| title_fullStr | Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease |
| title_full_unstemmed | Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease |
| title_short | Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease |
| title_sort | real world treatment selection factors and 7 year clinical outcomes between percutaneous coronary intervention and coronary artery bypass graft surgery in left main disease |
| topic | left main disease percutaneous coronary intervention coronary artery bypass surgery long-term outcomes real world decision making |
| url | https://www.mdpi.com/2077-0383/11/3/503 |
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