Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease—A single-center experience

Tse Min Lu, Wan Liang Lee, Pai Feng Hsu, Ting Chao Lin, Shih Hsien Sung, Kang Ling Wang, Shao Sung Huang, Wan Leong Chan, Chun Che Shih, Shing Jong Lin, Chiao Po Hsu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center. Methods We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85% male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7–6.5 years). Results All-cause death (PCI/CABG: 27.4%/31.5%; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8%/35.9%; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6%/11.0%; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results. Conclusion PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.

Original languageEnglish
Pages (from-to)356-362
Number of pages7
JournalJournal of the Chinese Medical Association
Volume79
Issue number7
DOIs
Publication statusPublished - Jul 1 2016
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Vessels
Cause of Death
Stroke
Myocardial Infarction
Propensity Score
Coronary Artery Disease
Mortality

Keywords

  • coronary artery bypass grafting
  • coronary stent
  • left main coronary artery disease
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease—A single-center experience. / Lu, Tse Min; Lee, Wan Liang; Hsu, Pai Feng; Lin, Ting Chao; Sung, Shih Hsien; Wang, Kang Ling; Huang, Shao Sung; Chan, Wan Leong; Shih, Chun Che; Lin, Shing Jong; Hsu, Chiao Po.

In: Journal of the Chinese Medical Association, Vol. 79, No. 7, 01.07.2016, p. 356-362.

Research output: Contribution to journalArticle

Lu, Tse Min ; Lee, Wan Liang ; Hsu, Pai Feng ; Lin, Ting Chao ; Sung, Shih Hsien ; Wang, Kang Ling ; Huang, Shao Sung ; Chan, Wan Leong ; Shih, Chun Che ; Lin, Shing Jong ; Hsu, Chiao Po. / Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease—A single-center experience. In: Journal of the Chinese Medical Association. 2016 ; Vol. 79, No. 7. pp. 356-362.
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abstract = "Background Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center. Methods We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85{\%} male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7–6.5 years). Results All-cause death (PCI/CABG: 27.4{\%}/31.5{\%}; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8{\%}/35.9{\%}; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6{\%}/11.0{\%}; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results. Conclusion PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.",
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T1 - Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease—A single-center experience

AU - Lu, Tse Min

AU - Lee, Wan Liang

AU - Hsu, Pai Feng

AU - Lin, Ting Chao

AU - Sung, Shih Hsien

AU - Wang, Kang Ling

AU - Huang, Shao Sung

AU - Chan, Wan Leong

AU - Shih, Chun Che

AU - Lin, Shing Jong

AU - Hsu, Chiao Po

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center. Methods We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85% male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7–6.5 years). Results All-cause death (PCI/CABG: 27.4%/31.5%; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8%/35.9%; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6%/11.0%; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results. Conclusion PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.

AB - Background Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center. Methods We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85% male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7–6.5 years). Results All-cause death (PCI/CABG: 27.4%/31.5%; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8%/35.9%; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6%/11.0%; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results. Conclusion PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.

KW - coronary artery bypass grafting

KW - coronary stent

KW - left main coronary artery disease

KW - percutaneous coronary intervention

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